Endoprosthesis having improved strain distribution

ABSTRACT

An endoprosthesis for delivery in a body lumen can be configured to inhibit structural fatigue, crack formation, and elastic recoil while providing improved crimping and expansion uniformity and radial strength. As such, the endoprosthesis can include at least one multi-stage crest element connecting adjacent bar arms. The multi-stage crest element and, optionally, the connection or transition between the multi-stage crest element and the bar arms can form a plurality of undulations or curves to improve the distribution of the strains experienced by the endoprosthesis. The improved strain distribution can improve the structural integrity and prevent failure of the endoprosthesis.

BACKGROUND OF THE INVENTION

1. The Field of the Invention

The present invention relates to an endoprosthesis for delivery anddeployment within a body vessel of a human or animal. More particularly,the invention relates to an endoprosthesis with improved straindistribution.

2. The Relevant Technology

Stents, grafts, and a variety of other endoprostheses are well known andused in interventional procedures, such as for treating aneurysms, forlining or repairing vessel walls, for filtering or controlling fluidflow, and for expanding or scaffolding occluded or collapsed vessels.Such endoprostheses can be delivered and used in virtually anyaccessible body lumen of a human or animal, and can be deployed by anyof a variety of recognized means. One recognized use of endoprostheses,such as stents, is for the treatment of atherosclerotic stenosis inblood vessels. For example, after a patient undergoes a percutaneoustransluminal coronary angioplasty or similar interventional procedure, astent is often deployed at the treatment site to improve the results ofthe medical procedure and to reduce the likelihood of restenosis. Thestent is configured to scaffold or support the treated blood vessel. Ifdesired, a stent can also be loaded with a beneficial agent so as to actas a delivery platform to reduce restenosis or for other beneficialpurposes.

An endoprosthesis is typically delivered by a catheter delivery systemto a desired location or deployment site inside a body lumen of a vesselor other tubular organ. To facilitate such delivery, the endoprosthesiscan be capable of having a particularly small cross-sectional profile toaccess deployment sites within small diameter vessels. Additionally, theintended deployment site may be difficult to access by a physician andcan involve traversing the delivery system through a tortuous luminalpathway. Thus, it can be desirable to provide the endoprosthesis with asufficient degree of flexibility during delivery to allow advancementthrough the anatomy to the deployed site. Moreover, it can be desirablefor the endoprosthesis to have sufficient strain distribution or crackand/or fatigue resistance so as to retain structural integrity duringand/or after being deployed and set.

Generally, an endoprosthesis can be constructed of multiple annularmembers or rings that are interconnected either through a connectionsection or a connection element. Accordingly, flexibility of theendoprosthesis can be controlled by the number and/or width of therings, the characteristics of connection sections or elements, and/orthe thickness of material that forms the rings and/or connectionelements. Although it is not specifically known how much vesselrestenosis can be attributed to stent rigidity, it is know that areasonably stiff stent may injure the vessel during motion (e.g., vesselcontraction and/or expansion during pulsatile blood flow). As such, itcan be desirable for an endoprosthesis to have sufficientflexibility/stiffness properties to enable deployment through a tortuousluminal pathway. Also, it can be desirable to change the stiffnessproperties of the endoprosthesis after deployment within a vessel.However, it can also be important for the endoprosthesis to retain itsstructural integrity after deployment by being configured to inhibit theformation and/or propagation of cracks as well as resist structuralfatigue.

Once deployed, the endoprosthesis can be capable of satisfying a varietyof performance characteristics. The endoprosthesis can be sufficientlyrigid or provide an outwardly-oriented bias when deployed to perform itsintended function, such as opening a lumen or supporting a vessel wall.Similarly, the endoprosthesis can have suitable flexibility along itslength and/or width to inhibit any kinking or straightening that mayoccur during deployment or setting within the tortuous luminal pathway.

A significant failure mode in endoprostheses can be a result ofsignificant and/or localized strains that the endoprostheses experienceduring crimping, deployment, and/or setting. These significant and/orlocalized strains can result in elastic spring-back or recoil duringcrimping and/or expansion of the endoprostheses. These strains can alsolead to distortion, structural fatigue, and/or crack formation in theendoprostheses. For example, failure can result from a stent element,such as an elbow, beginning to crack during crimping, setting, and/oruse. Such cracks can also form and/or propagate through the material ofthe endoprosthesis as a result of the cyclic loading that the stentundergoes during the pulsatile movement of blood and associated vesselexpansion and contraction.

Although various endoprostheses have been developed to address one ormore of the aforementioned performance shortcomings, there remains aneed for a more versatile design that improves one or more performancecharacteristics without sacrificing the remaining characteristics.Therefore, it would be advantageous to have an endoprosthesis configuredto have increased and/or enhanced strain distribution to resist crackingor fatiguing during crimping, deployment, setting, and/or use.Additionally, it would be beneficial for the endoprosthesis to havesufficient strength and flexibility to enable deployment throughtortuous luminal pathways while retaining the ability to perform itsintended function.

BRIEF SUMMARY OF THE INVENTION

Generally, the present invention includes an endoprosthesis for deliveryinto a lumen of a body. The endoprosthesis can be configured to haveimproved strain distribution characteristics to improve crack and/orfatigue resistance so as to retain substantial structural integrityduring and/or after deployment. The improvement in strain distributioncan inhibit crack formation and/or propagation and/or fatigue-inducedcatastrophic failure, thereby improving the performance and reliabilityof the endoprostheses. The inhibition of catastrophic failure canprevent portions of the endoprostheses from puncturing the lumen ordamaging the tissue of the lumen. Thus, inhibiting crack formationand/or propagation and/or fatigue-induced catastrophic failure canimprove the safety and longevity of endoprostheses.

In one embodiment, the present invention can include an endoprosthesisfor delivery in a body lumen that has at least one annular ringconfigured to be crimped into a delivery configuration and expanded intoa deployed configuration to provide scaffolding support to a lumen. Theat least one annular ring can include a plurality ofcircumferentially-adjacent bar arms, each of which has a first end and asecond end. The at least one annular ring can also include at least onemulti-stage crest element connecting a first end of one bar arm to afirst end of a second, circumferentially-adjacent bar arm. The at leastone multi-stage crest element has a plurality of link arms connected toone another with a plurality of elbows. For example, the multi-stagecrest element may include five elbows connecting four link arms togetherend to end.

In some embodiments, the endoprosthesis includes a plurality oflongitudinally spaced apart annular rings, each of which is connected toat least one other annular ring with at least one connector. The atleast one connector can be connected to a multi-stage crest element of afirst annular ring and a multi-stage crest element of a second annularring.

In some embodiments, link arms from the plurality of link arms andelbows from the plurality of elbows are connected to one another todefine an opening through the at least one multi-stage crest element.The opening can be generally diamond shaped. The opening in the at leastone multi-stage crest element can longitudinally lengthen and verticallyshorten when the at least one annular ring is crimped into the deliveryconfiguration. Likewise, the opening in the at least one multi-stagecrest element can longitudinally shorten and vertically lengthen whenthe at least one annular ring is expanded into the deployedconfiguration.

Whether or not link arms and elbows define an opening in the multi-stagecrest element, the arrangement and configuration of the plurality oflink arms and the plurality of elbows can be adapted to distributestrains experienced by the at least one annular ring during crimping andexpansion. This distribution of strains can limit recoil, crackformation, structural fatigue, or other potential failures and as wellas improve structural integrity and radial strength. In someembodiments, the first end of each bar arm of the plurality of bar armsis connected to a multi-stage crest element that opens in a firstdirection and the second end of each bar arm of the plurality of bararms is connected to a multi-stage crest element that opens in a seconddirection. This leads to an alternating pattern that results in moreuniform crimping and expansion.

In some embodiments of the invention, the strains experienced by the atleast one annular ring during crimping and expansion include acombination of compressive strains and tensile strains. In such anembodiment, each elbow of the plurality of elbows can experience both atensile strain and a compressive strain when the at least one annularring is in the delivery configuration and in the deployed configuration.In some embodiments, at least three elbows of the plurality of elbowsinclude a strain region that experiences a tensile strain when the atleast one annular ring is in the delivery configuration and acompressive strain when the at least one annular ring is in the deployedconfiguration; and a strain region that experiences a compressive strainwhen the at least one annular ring is in the delivery configuration anda tensile strain when the at least one annular ring is in the deployedconfiguration. Similarly, in some embodiments at least two elbows of theplurality of elbows include a strain region that experiences a tensilestrain when the at least one annular ring is in the deliveryconfiguration and when the at least one annular ring is in the deployedconfiguration; and a strain region that experiences a compressive strainwhen the at least one annular ring is in the delivery configuration andwhen the at least one annular ring is in the deployed configuration.

In some configurations of the present invention, the distances betweenat least three of the elbows of the at least one multi-stage crestelement are adapted to change as the at least one annular ring expandsfrom the delivery configuration to the deployed configuration. Variousconfigurations of the invention may also include a plurality of linkarms that are oriented obliquely to a longitudinal axis of the at leastone annular ring when the at least one annular ring is in the deliveryconfiguration. Similarly, each of the plurality of bar arms can beoriented obliquely to the longitudinal axis of the at least one annularring when the at least one annular ring is in the deliveryconfiguration. Furthermore, the plurality of bar arms can be orientedgenerally perpendicular to the longitudinal axis of the at least oneannular ring when the at least one annular ring is in the deployedconfiguration.

In another embodiment, the present invention can include anendoprosthesis for delivery in a body lumen that includes a plurality oflongitudinally spaced apart annular rings configured to be crimped intoa delivery configuration and expanded into a deployed configuration toprovide scaffolding support to a lumen. Each of the plurality oflongitudinally spaced apart annular rings can include a plurality ofcircumferentially-adjacent bar arms, each of which has a first end and asecond end. Each of the plurality of longitudinally spaced apart annularrings can also include a plurality of multi-stage crest elementsconnecting the first ends of circumferentially-adjacent bar arms to oneanother and a plurality of multi-stage crest elements connecting thesecond ends of circumferentially-adjacent bar arms to one another. Themulti-stage crest elements have a plurality of link arms connected toone another with a plurality of elbows. The plurality of link arms andthe plurality of elbows are connected in an arrangement adapted tosufficiently distribute strains experienced by each annular ring duringcrimping and expansion to limit structural fatigue and damage to eachannular ring and to facilitate substantially uniform crimping andexpansion of each annular ring. The endoprosthesis can also include aplurality of connectors connecting each annular ring to at least oneother annular ring.

In some embodiments, the link arms from the plurality of link arms andelbows from the plurality of elbows are connected to one another todefine a generally diamond shaped opening through each multi-stage crestelement. In other embodiments, the plurality of multi-state crestelements that connect the first ends of circumferentially-adjacent bararms to one another and the plurality of multi-state crest elements thatconnect the second ends of circumferentially-adjacent bar arms to oneanother are circumferentially offset from one another to facilitate thesubstantially uniform crimping and expansion of each annular ring.

These and other objects and features of the present invention willbecome more fully apparent from the following description and appendedclaims, or may be learned by the practice of the invention as set forthhereinafter.

BRIEF DESCRIPTION OF THE DRAWINGS

To further clarify the above and other advantages and features of thepresent invention, a more particular description of the invention willbe rendered by reference to specific embodiments thereof which areillustrated in the appended drawings. It is appreciated that thesedrawings depict only illustrated embodiments of the invention and aretherefore not to be considered limiting of its scope. The invention willbe described and explained with additional specificity and detailthrough the use of the accompanying drawings in which:

FIG. 1 illustrates a planar side view of a portion of an embodiment ofan exemplary endoprosthesis in accordance with the invention;

FIG. 1A illustrates a planar side view of a multi-stage crest elementand associated bar arms of the endoprosthesis of FIG. 1;

FIG. 2 is a planar side view of the portion of the exemplaryendoprosthesis of FIG. 1 in a compacted, crimped, or deliveryconfiguration;

FIG. 3 is a planar side view of the portion of the exemplaryendoprosthesis of FIG. 1 in an expanded, deployed, or set configuration;

FIG. 4 is a planar side view of a multi-stage crest element of theexemplary endoprosthesis of FIG. 1 illustrating an exemplary improvedstrain distribution provided by the multi-stage crest element when theendoprosthesis is in a compacted, crimped, or delivery configuration;

FIG. 5 is a planar side view of the multi-stage crest element of theexemplary endoprosthesis of FIG. 5 illustrating an exemplary improvedstrain distribution provided by the multi-stage crest element when theendoprosthesis is in an expanded, deployed, or set configuration;

FIG. 6 illustrates a planar side view of a portion of another embodimentof an exemplary endoprosthesis in accordance with the invention;

FIG. 6A illustrates a planar side view of a multi-stage crest elementand associated bar arms of the endoprosthesis of FIG. 6;

FIG. 7 is a planar side view of the portion of the exemplaryendoprosthesis of FIG. 6 in a compacted, crimped, or deliveryconfiguration;

FIG. 8 is a planar side view of the portion of the exemplaryendoprosthesis of FIG. 6 in an expanded, deployed, or set configuration;

FIG. 9 is a planar side view of a multi-stage crest element of theexemplary endoprosthesis of FIG. 6 illustrating an exemplary improvedstrain distribution provided by the multi-stage crest element when theendoprosthesis is in a compacted, crimped, or delivery configuration;and

FIG. 10 is a planar side view of the multi-stage crest element of theexemplary endoprosthesis of FIG. 9 illustrating an exemplary improvedstrain distribution provided by the multi-stage crest element when theendoprosthesis is in an expanded, deployed, or set configuration.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The present invention includes various embodiments of endoprostheses fordelivery into a lumen of a body of a human or other animal. Theendoprostheses can be configured to limit or prevent fatigue,distortion, recoil upon crimp or expansion, and/or the formation ofcracks, and to promote structural integrity, radial strength, and/orgenerally uniform expansion by improving the strain distributionexperienced by the endoprostheses upon crimping, deployment, expansion,and use. Thus, the endoprostheses having the improved straindistribution can retain substantial structural integrity during and/orafter deployment.

The improvement in endoprosthetic structural integrity from strutelements having improved strain distribution can inhibit fatigue-inducedcatastrophic failure, such as deformation and/or crack formation,thereby improving the performance and reliability of the endoprostheses.The inhibition of catastrophic failure can prevent portions of theendoprostheses from puncturing the lumen or damaging the tissue of thelumen. Thus, inhibiting fatigue-induced catastrophic failure, such ascrack formation, can improve the safety and longevity of endoprostheses.Strut elements having improved strain distribution can also improve theperformance and reliability of the endoprostheses by limiting the amountof recoil or elastic spring-back experienced during crimping and/orexpansion of the endoprosthesis. Limiting recoil can improve thedeployment and setting results, thereby increasing the ease of use ofthe endoprostheses and improving the patient outcomes as a result ofusing the improved strain distribution endoprostheses.

Generally, improvements in structural integrity and performance ofendoprostheses can be accomplished by reducing the amount of strainexperienced by any given element of the endoprostheses. Reducing theamount of strain experienced by any given endoprosthesic element canserve to inhibit fatigue-induced failure, recoil, and/or distortion ofor crack formation in the endoprosthetic element. Moreover, suchstrain-reducing features can also increase the crimping and/or expansionuniformity in the endoprostheses as well as improve the radial strengthof the endoprostheses.

An endoprosthesis can have various configurations. Examples of someendoprostheses can include stents, filters, grafts, valves, occlusivedevices, trocars, aneurysm treatment devices, or the like. Additionally,an endoprosthesis can be configured for a variety of intralumenalapplications, including vascular, coronary, biliary, esophageal,urological, gastrointestinal, nasal, or the like. While variousembodiments of endoprostheses and endoprosthetic elements are describedin more detail below, it should be recognized that these embodiments arenot limiting and the principles of the present invention can extend toother embodiments of endoprostheses.

In accordance with the present invention, endoprostheses having specificpatterns will be described. It shall be understood that the followingdescription of the endoprostheses should not be considered limiting inany manner and that the invention is independent of these endoprosthesespatterns. For example, it is contemplated that the present invention maybe practiced in accordance with endoprosthesis patterns having: annularrings, connection sections, connectors, bar arms, link arms, elbows,open cell patterns, close cell patterns, and the like.

Generally, an endoprosthesis of the present invention can include atleast a first set of interconnected strut elements that cooperativelydefine an annular ring or ring. Usually, each strut element can bedefined by a cross-sectional profile having a width and a thickness, andinclude a first end and a second end bounding a length. The length canbe characterized as being substantially linear, arced, rounded, squared,other configurations, and/or combinations thereof. The annular ring canhave improved structural integrity by including a plurality ofcurvatures and/or undulations in an amount, distribution, pattern,shape, and/or configuration that can improve the distribution of thevarious strains experienced by the annular ring. As discussed herein,improved strain distribution can reduce structural fatigue, inhibitcrack formation, distortion, and elastic recoil, as well as providegreater uniformity in crimping and expansion and increased radialstrength. The strut elements of the annular ring can include bar arms,multi-stage crest elements, crests, valleys, connectors, elbows, linkarms, combinations thereof, or the like, as described in more detailbelow.

Usually, the annular rings can include a plurality ofcircumferentially-adjacent bar arms that are interconnected end-to-endby multi-stage crest elements. As such, at least one annular ring caninclude a multi-stage crest element extending between at least one pairof circumferentially-adjacent bar arms. The multi-stage crest elementcan thus define an apex between the pair of circumferentially-adjacentbar arms of the annular ring. The configuration of the multi-stage crestelements and, optionally, the connection or transition between themulti-stage crest elements and the bar arms can improve the distributionof the various strains experienced by the annular ring, therebyimproving the structural integrity and performance of the annular ringand reducing the likelihood of structural fatigue, crack formation, orother failures.

As described above, the present invention will be described inaccordance with specific endoprosthesis designs; these should not beconsidered limiting in any manner. The concepts described herein inaccordance with the present invention may be applied to otherendoprosthesis designs wherein, in accordance with those designs, theplacement of the certain features may differ from that shown ordescribed herein.

In one embodiment, an endoprosthesis can include two or moreinterconnected annular rings. As such, the endoprosthesis can include atleast a second set of interconnected strut elements defining at least asecond annular ring. Also, the endoprosthesis can include additionalannular rings defined by interconnected strut elements as describedherein or well known in the art. Each annular ring can generally definea ring-like structure extending circumferentially about a longitudinalor central axis. The cross-sectional profile of each annular ring can bearcuate, circular, helical, spiral, or the like, although alternativecross-sectional profiles, such as oval, oblong, rectilinear, or thelike, can be used.

In one embodiment, a first annular ring can be aligned longitudinallyadjacent to a second annular ring along the longitudinal axis, andconnected to each other through at least one connector element thatextends therebetween. The connector element can be considered to be astrut element for the purposes of the invention. As such, the connectorelement can be a strut element that interconnects adjacent annularrings.

Preferably, at least the first and second annular rings generally definea tubular structure. For example, each annular ring can define acontinuous closed ring such that the longitudinally-aligned annularrings form a closed tubular structure having a central longitudinalaxis. Alternatively, each annular ring can define an open ring shapesuch as a rolled sheet, open tubular, or “C-shape” type structure. Thatis, the annular ring is not required to be closed. Furthermore, eachannular ring can define substantially a 360-degree turn of a helicalpattern or spiral, such that the end of one annular ring can be joinedwith the corresponding end of a longitudinally-adjacent annular ring todefine a continuous helical pattern along the length of theendoprosthesis. Moreover, various other annular and endoprostheticshapes and configurations can be employed within the present inventionand modifications thereto can be made by one of ordinary skill in theart.

Each bar arm of the annular rings can include a first end and a secondend. The bar arms of each annular ring can be disposedcircumferentially-adjacent to each other and interconnected throughmulti-stage crest elements so as to define an expandable structure. Forexample, and with reference to the closed tubular structure describedabove, circumferentially-adjacent bar arms of each annular ring can beinterconnected, either directly or indirectly, in an end-to-end formatby multi-stage crest elements to define a continuous ring having agenerally circular cross-sectional profile. By altering the angle ordistance defined between circumferentially-adjacent bar arms, thetubular structure can be radially expanded between a deliveryconfiguration and a deployed configuration. As discussed in detailbelow, the expandable structure can be expanded by the application of anexternal force, such as by a balloon, or by a change in deliveryconditions, such as an increase in temperature or the removal of arestraint, so as to allow the structure to self expand.

In one embodiment, one or more of the multi-stage crest elements of anannular ring can include a plurality of elbows connected together by aplurality of link arms. The plurality of elbows and the plurality oflink arms cooperate to distribute the strain experienced by themulti-stage crest element to prevent distortion, structural fatigue,crack formation, or other types of failures. The inclusion of theplurality of elbows, in particular, enables the strain experienced bythe multi-stage crest element to be distributed between the variouselbows of the plurality of elbows, thereby reducing the strainexperienced by any one of the elbows. Distributing the strain among thevarious elbows of the multi-stage crest element reduces the likelihoodthat the strain experienced by any one of the elbows will be sufficientto cause significant structural fatigue, cracking, or other type offailure. As will be understood by one or ordinary skill in the art, andin light of the disclosure herein, the strain experienced by themulti-stage crest element may be a result of the forces applied to theendoprosthesis in order to crimp the endoprosthesis into a deliveryconfiguration or expand the endoprosthesis into a deployedconfiguration, or the pulsative forces applied to the endoprosthesis byvessel contraction and/or expansion during pulsatile blood flow.

FIG. 1 is a side view of a flattened portion of an embodiment of anendoprosthesis 100 that can include one or more multi-stage crestelements. For purpose of illustration and not limitation, arepresentative embodiment of endoprosthesis 100 of the present inventionis depicted in a planar format for clarity. Endoprosthesis 100 as shownin FIG. 1 is in a cut or formation configuration. In other words, whenendoprosthesis 100 is made, it can be formed as shown in FIG. 1. Asdiscussed herein, after forming endoprosthesis 100 as shown in FIG. 1,endoprosthesis 100 can be crimped into a delivery configuration orexpanded into a deployed configuration. Endoprosthesis 100 could also beformed in a crimped configuration that could be expanded to a deployedconfiguration. Likewise, endoprosthesis 100 could also be formed in adeployed configuration, which could then be crimped into a deliveryconfiguration.

As shown, endoprosthesis 100 can include a plurality of annular rings102 aligned longitudinally adjacent to each other along a longitudinalaxis 106. Although only one annular ring need be provided in accordancewith the invention, endoprosthesis 100 can include a plurality ofannular rings 102, depicted herein for purpose of illustration byannular rings 102 a-102 d.

Each annular ring 102 can include a set of interconnected bar arms 110,which are disposed circumferentially about the longitudinal axis 106.Arrows 108 illustrates the circumferential directionality. Each bar arm110 can have a first end 112 and a second end 114. First ends 112 of bararms 110 interconnect to multi-stage crest elements 116 that areproximate to a first longitudinal side 118 of annular ring 102 of whichthe elements are a part. Similarly, second ends 114 of bar arms 110interconnect to multi-stage crest elements 116 that are proximate to asecond longitudinal side 120 of annular ring 102. Thus, bar arms 110 canbe linked to one another through multi-stage crest elements 116, therebyforming a generally zigzag-type pattern.

The configuration and arrangement of multi-stage crest elements 116 andbar arms 110 of the illustrated embodiment may provide the illustratedendoprosthesis 100 with numerous benefits. As discussed in greaterdetail below, the configuration and arrangement of the components ofmulti-stage crest elements 116 and bar arms 110 may distribute thestrains experienced by endoprosthesis 100 during crimp, expansion, anduse. This distribution of strains can improve the structural integrityand performance of endoprosthesis 100 by limiting the strain on anygiven point on endoprosthesis 100 to a level that is unlikely to causefatigue, distortion, cracking, or other type of failure. Further, thearrangement of the components of multi-stage crest elements 116 and bararms 110 and the resulting improved stress distribution can limit theamount of elastic spring-back or recoil observed as endoprosthesis 100is crimped or expanded. Moreover, the configuration and arrangement ofmulti-stage crest elements 116 and bar arms 110 also enable more uniformcrimping and expansion of annular rings 102 of endoprosthesis 100. Stillfurther, the arrangement of multi-stage crest element 116 components andadjacent bar arms 110 relative to one another limits the amount of forcerequired to crimp or expand each annular ring 102. This arrangement alsoimproves the radial strength of annular rings 102.

As noted herein, each multi-stage crest element 116 can include multiplelink arms, elbows, joints, crests, valleys, connectors, combinationsthereof, or the like. As shown in FIGS. 1-5, the exemplary illustratedembodiment of multi-stage crest element 116 includes link arms 122, 124,126, 128 connected together via elbows 130, 132, 134. Multi-stage crestelement 116 also includes transition elbows 136, 138 for connecting ortransitioning multi-stage crest element 116 tocircumferentially-adjacent bar arms 110, such as bar arms 110 a, 110 b.More specifically, as shown in FIG. 1A, first end 112 of bar arm 110 ais connected to an end of transition elbow 136 of multi-stage crestelement 116. An opposing end of transition elbow 136 is connected to anend of link arm 122, while an opposing end of link arm 122 is connectedto an end of elbow 130. An opposing end of elbow 130 is connected to anend of link arm 124, while an opposing end of link arm 124 is connectedto an end of elbow 132. Link arms 122, 124 and elbows 136, 130, 132 thuscooperate to form a first half of multi-stage crest element 116.

In the illustrated embodiment, a second half of multi-stage crestelement 116 is substantially a mirror image of the first half ofmulti-stage crest element 116 (when multi-stage crest element 116 isreflected across the middle of elbow 132 along a line that issubstantially parallel to longitudinal axis 106). That is, an opposingend of elbow 132 (the end of elbow 132 opposite the end that connects tolink arm 124) connects to an end of link arm 126. An opposing end oflink arm 126 connects to an end of elbow 134, while an opposing end ofelbow 134 connects to an end of link arm 128. An opposing end of linkarm 128 connects to an end of transition elbow 138, while an opposingend of transition elbow 138 connects to a first end 112 of bar arm 110b.

It will be understood that when this description refers to the variouslink arms, elbows, connectors, and the like, being “connected” to oneanother, use of the term “connected” is not intended to be limiting inany way. For instance, a link arm and an elbow can be consideredconnected whether these elements are initially formed separately andlater joined or linked together, or these elements are formed as anintegral or single piece. In either case, these various components canbe considered to be connected as long as they are linked, joined,attached, integrally formed, or otherwise physically associated witheach other.

As seen in FIGS. 1-3, each annular ring 102 can be formed with agenerally uniform and/or alternating pattern. For instance, just asfirst ends 112 of circumferentially-adjacent bar arms 110 are connectedtogether via multi-stage crest elements 116, so too are second ends 114of circumferentially-adjacent bar arms 110 connected together viamulti-stage crest elements 116. More particularly, as shown in FIG. 1,second ends 114 of bar arms 110 a, 110 b are each connected totransition elbows of multi-stage crest elements 116 which are disposedalong second longitudinal side 120 of annular ring 102 a and which arecircumferentially-adjacent to one another.

As can also be seen in FIG. 1, while multi-stage crest elements 116disposed along second longitudinal side 120 of annular ring 102 a arecircumferentially offset from multi-stage crest elements 116 disposedalong first longitudinal side 118 of annular ring 102 a, multi-stagecrest elements 116 disposed along second longitudinal side 120 ofannular ring 102 a are substantially mirror images of multi-stage crestelements 116 disposed along first longitudinal side 118 of annular ring102 a. In other words, if multi-stage crest element 116 a were rotatedabout radial axis 140 (which extends radially from longitudinal axis 106through a midpoint of bar arm 110 a), multi-stage crest element 116 awould lie in and fill the same space as multi-stage crest element 116 b.Likewise, if multi-stage crest element 116 b were rotated about radialaxis 140, multi-stage crest element 116 b would lie in and fill the samespace as multi-stage crest element 116 a.

Thus, annular ring 102 a is formed of a plurality ofcircumferentially-adjacent multi-stage crest elements 116 along firstlongitudinal side 118 and a plurality of circumferentially-adjacentmulti-stage crest elements 116 along second longitudinal side 120. Whilemulti-stage crest elements 116 along second longitudinal side 120 arecircumferentially offset from multi-stage crest elements 116 along firstlongitudinal side 118, multi-stage elements 116 from each longitudinalside can be considered to be substantially mirror images of one another.In other words, if multi-stage crest elements 116 from each longitudinalside were not circumferentially offset from one another, multi-stagecrest elements 116 from each longitudinal side would be mirror images ofone another (when reflected across a line substantially parallel tocircumferential directionality arrow 108).

The above-described offset and mirrored arrangement of multi-stage crestelements 116 provides annular ring 102 a with an alternating pattern.Multi-stage crest elements 116 along first longitudinal side 118 can besaid to open toward second longitudinal side 120, while multi-stagecrest elements 116 along second longitudinal side 120 can be said toopen toward first longitudinal side 118. By alternating or offsettingthe circumferential locations of multi-stage crest elements 116 on firstand second longitudinal sides 118, 120, as well as configuring eachmulti-stage crest element 116 in a similar manner, annular ring 102 a isable to be radially crimped or expanded in a generally uniform manner.

That is, as annular ring 102 a is radially crimped or expanded, eachmulti-stage crest elements 116 will crimp or expand in a similar way andto a similar degree as each of the other multi-stage crest elements 116.More specifically, as annular ring 102 a is radially crimped orexpanded, each multi-stage crest element along first longitudinal side118 will crimp or expand a certain amount. This crimping or expansionwill increase or decrease the radius of annular ring 102 a along firstlongitudinal side 118. Because each of multi-stage crest elements 116will crimp or expand substantially the same amount (due to their similarconfigurations), the radius of annular ring 102 a along firstlongitudinal side 118 will be substantially uniform as annular ring 102a is crimped or expanded. Likewise, as annular ring 102 a is radiallycrimped or expanded, each multi-stage crest element along secondlongitudinal side 120 will crimp or expand a certain amount. Thiscrimping or expansion will increase or decrease the radius of annularring 102 a along second longitudinal side 120. Because each ofmulti-stage crest elements 116 along second longitudinal side 120 willcrimp or expand substantially the same amount, the radius of annularring 102 a along second longitudinal side 120 will be substantiallyuniform as annular ring 102 a is crimped or expanded.

While the uniformity among the multi-stage crest elements 116 enableseach longitudinal side 118, 120 to maintain a substantially uniformradius, the offset configuration of multi-stage crest elements 116 alongthe second longitudinal side 120 relative to multi-stage crest elements116 along first longitudinal side 118 ties the radial expansion orcontraction of first and second longitudinal sides 118, 120 together andmaintains a generally uniform radius for annular ring 102 a as a whole.

As discussed below, the configurations of elbows 130, 132, 134, 136, 138and the relative positioning and orientation of bar arms 110 and linkarms 122, 124, 126, 128 relative to one another that result from theconfiguration of elbows 130, 132, 134, 133, 138 provide many of thebenefits and advantages of the present invention. While variousexemplary configurations of the endoprosthesis components will bediscussed below, including orientations, angles, bends, curvatures,strain locations, and the like, it will be understood that the describedconfigurations are exemplary only. The various components of anendoprosthesis according to the present invention can have otherconfigurations without departing from the scope of the invention.

As seen in FIGS. 1 and 1A, when endoprosthesis 100 is formed, elbows130, 132, 134, 136, 138 orient bar arms 110 and link arms 122, 124, 126,128 at various angles relative to one another, longitudinal axis 106,and circumferential directionality arrow 108. By way of example, bararms 110 are connected between opposing multi-stage crest elements 116so that first end 112 and second end 114 are both circumferentially andlongitudinally offset from one another. Stated another way, bar arms 110are connected to multi-stage crest elements 116 on opposing longitudinalsides 118, 120 of annular ring 102 so that bar arms 110 are obliquelyoriented relative to longitudinal axis 106 and circumferentialdirectionality arrow 108. As used herein, the terms oblique andobliquely are intended to mean oriented at an angle other than 90° or180°.

As discussed above, the ends 112, 114 of bar arms 110 are each connectedto a multi-stage crest elements 116 via transition elbows. For instance,first end 112 of bar arm 110 a is connected to an end of transitionelbow 136. The opposing end of transition elbow 136 is connected to linkarm 122. Link arm 122 is connected between transition elbow 136 andelbow 130 so that link arm 122 is obliquely oriented relative tolongitudinal axis 106 and circumferential directionality arrow 108. Thatis to say link arm 122 is connected between transition elbow 136 andelbow 130 so that the opposing ends of link arm 122 are bothcircumferentially and longitudinally offset from one another. Orientingbar arm 110 and link arm 122 in this matter creates an obtuse anglebetween bar arm 110 and link arm 122. In some embodiments, bar arm 110and link arm 122 are oriented to form either an acute or right angle.

The orientation of link arm 122 provides significant benefits tomulti-stage crest element 116. For instance, the above-described obliqueorientation of link arm 122 creates an angle between multi-stage crestelement 116 and bar arm 110 a that allows for greater reorientation ofbar arm 110 a and link arm 122 during crimp or expansion. As bar arm 110a and link arm 122 are reoriented relative to one another during crimpor expansion, elbow 136 experiences some of the strain created by thecrimping or expansion. Due to the original curvature of elbow 136 thatresults from the oblique orientation of link arm 122, a greater amountof strain can be distributed through elbow 136 without causingstructural fatigue or failure.

Moving around multi-stage crest element 116 a, an opposing end of linkarm 122 is connected to an end of elbow 130, which is generallyU-shaped. The other end of elbow 130 is connected to an end of link arm124. The general U-shape of elbow 130 orients link arm 124 generallyparallel to link arm 122 when endoprosthesis 100 is formed. Since linkarm 124 is generally parallel to link arm 122, link arm 124 is alsoobliquely oriented relative to longitudinal axis 106, circumferentialdirectionality arrow 108, and bar arm 110 a. As such, the opposing endsof link arm 124 are circumferentially offset from one another. In someembodiments, elbow 130 can be configured to orient link arms 122, 124 toform an acute, right, or an obtuse angle.

An opposing end of link arm 124 is connected to elbow 132, which in turnconnects to an end of link arm 126. Elbow 132 is configured to orientlink arms 124, 126 so as to form a general V-shape. In thisconfiguration, link arm 126 is oriented generally parallel to bar arm110 a and oblique to longitudinal axis 106, circumferentialdirectionality arrow 108, and link arms 122, 124. Thus, the opposingends of link arm 124 are circumferentially offset from one another.Elbow 132 can be configured to orient link arms 124, 126 to form anacute or right angle. In other embodiments, elbow 132 can be configuredto orient link arms 124, 126 to form an obtuse angle.

Similar to link arms 122, 124 and elbow 130, link arm 126 is connectedto elbow 134, which in turn connects to link arm 128. Elbow 134 isgenerally U-shaped so as to orient link arms 126, 128 generally parallelto one another. Nevertheless, elbow 134 can be configured to orient linkarms 126, 128 to form an acute, right, or an obtuse angle. In theillustrated embodiment, in which elbow 134 is generally U-shaped, linkarm 128 is oriented in a similar manner as link arm 126. That is, linkarm 128 is oriented generally parallel to bar arm 110 a and oblique tolongitudinal axis 106, circumferential directionality arrow 108, andlink arms 122, 124. Thus, the opposing ends of link arm 128 arecircumferentially offset from one another

Finally, link arm 128 is connected to bar arm 110 b via transition elbow138 in an arrangement similar to the connection of bar arm 110 a andlink arm 122 via transition elbow 136. More specifically, theconfiguration of transition elbow 138 is such that bar arm 110 b andlink arm 128 form an obtuse angle, and bar arm 110 b is orientedgenerally parallel to link arms 122, 124 and oblique to link arms 126,128, bar arm 110 a, longitudinal axis 106, and circumferentialdirectionality arrow 108. In other embodiments, transition elbow 138 canorient link arm 128 and bar arm 110 b to form an acute or right angle.In any case, the opposing ends of link arm 128 are bothcircumferentially and longitudinally offset from one another, therebyproviding the same strain distributing benefits described above inconnection with link arm 122 and bar arm 110 a.

As with bar arm 110 a, first and second ends 112, 114, respectively, ofbar arm 110 b can be connected between opposing multi-stage crestelements 116 so that first end 112 and second end 114 arecircumferentially offset from one another. As described above andillustrated in the Figures, bar arms 110 and the link arms 122, 128(from multi-stage crest elements 116 on opposing longitudinal sides ofannular ring 102) create an arrangement that resembles a sinusoidalwave. For instance, when viewed from right to left, link arm 122 ofmulti-stage crest element 116 a has a downward slope, bar arm 110 a hasan upward slope, and link arm 128 of multi-stage crest element 116 b hasa downward slope. This arrangement of bar arms 110 and link arms 122,128 of opposing multi-stage crest elements 116 is one of the featuresthat contributes to the benefits of endoprosthesis 100. As mentionedabove and discussed in greater detail below, orienting bar arms 110 andlinks arms 122, 128 in this manner helps distribute strains experiencedduring crimping and expansion of endoprosthesis 100, thereby preventingstructural fatigue, recoil, and/or failure.

Each annular ring 102 can be crimped or compressed to a deliveryconfiguration as shown in FIG. 2 by altering the angles of elbows 130,132, 134, 136, 138 of multi-stage crest elements 116 and/or the anglesbetween circumferentially-adjacent bar arms 110. Also,circumferentially-adjacent multi-stage crest elements 116 on each side118, 120 of annular ring 102 can be spaced apart by a circumferentialdistance D, such that each annular ring 102 is crimped by decreasing thedistance D between circumferentially-adjacent multi-stage crest elements116. Correspondingly, each annular ring 102 can be expanded to adeployed configuration as shown in FIG. 3 by altering the angles ofelbows 130, 132, 134, 136, 138 of multi-stage crest elements 116 and/orthe angles of between the circumferentially-adjacent bar arms 110. Also,annular ring 102 can be expanded by increasing the distance D betweencircumferentially-adjacent multi-stage crest elements 116. At any givencondition between the delivery configuration and the deployedconfiguration, the distance D can be balanced or constant from onecircumferentially-adjacent multi-stage crest element 116 to the next, orcan be varied if desired.

In the illustrated embodiment of endoprosthesis 100, a plurality ofconnectors 104 are provided to connect adjacent annular rings 102 a-d.Each connector 104 includes a first end 142, a second end 144, and anintermediate portion 146. In the illustrated embodiment, first end 142connects to a multi-stage crest element 116 on one of annular rings 102a-d, and second end 144 connects to a multi-stage element 116 on anadjacent annular ring 102. According to the illustrated embodiment,first and second ends 142, 144 of connectors 104 connect to innersurfaces of elbows 132. Corresponding multi-stage crest elements 116 onadjacent annular rings 102 (e.g., multi-stage crest elements 116 thatare connected together via a connector 104) open toward one another suchthat the crests or peaks of elbows 132 point generally toward oneanother. Connectors 104 connect to the crests or peaks of correspondingelbows 132 to join or connect adjacent annular rings 102.

As shown in FIGS. 1-3, intermediate portion 146 of connector 104 has ageneral U-shape. In other embodiments, intermediate portion can includeother shapes, including curves, straight segments, angles, bends,combinations thereof, and the like to suit a particular need or desire.Forming intermediate portion 146 with curve, bends, angles, and the likecan provide some versatility and flexibility to endoprosthesis 100. Byway of example, inclusion of such features can enable endoprosthesis tobend more easily as it is passed through a tortuous luminal pathway.Additionally, the inclusion of bends, curves, angles, and the like canalso facilitate longitudinal expansion or contraction of endoprosthesiswith minimal risk of connector 104 fatiguing, cracking, breaking, orotherwise failing.

As illustrated, not all of multi-stage crest elements 116 need to beconnected to a connector 104. Rather, the number and spacing betweenconnectors 104 can be adjusted based on the particular need associatedwith the endoprosthesis. For instance, adjacent annular rings 102 can beconnected with as few as one connector 104, or can include numerousconnectors. Additionally, connectors 104 can be connected to annularrings 102 at various locations. For instance, connectors 104 can connectto bar arms, elbows, link arms, any combination thereof, and the like.Additionally, connectors 104 need not extend parallel to longitudinalaxis 106, but can be aligned diagonally or helically such that ends 142,144 of connectors 104 are circumferentially offset.

For simplicity and clarity, each bar arm 110 and link arm 122, 124, 126,128 depicted in FIGS. 1-5 is shown to be a straight member. It isrecognized, however, that bar arms 110 and link arms 122, 124, 126, 128can be contoured, shaped, or sized to increase flexibility if desired.Additionally, each bar arm 110 of annular ring 102 can be a straightmember or have various curves or shapes similar to the connectors 104.When in a closed delivery configuration, bar arms 110 can be obliquelyoriented to longitudinal axis 106, as well as to each other, asdescribed above and as shown in FIG. 2. When in an open deployedconfiguration, multi-stage crest elements 116 can be expanded and bararms 110 can be oriented generally perpendicular to longitudinal axis106, as shown in FIG. 3, so that each annular ring 102 forms (whenviewed in a plane) a generally vertical column or column-like structure.Such a configuration provides enhanced radial strength to annular rings102. Nevertheless, in an alternative embodiment, bar arms 110 can beoriented generally obliquely to longitudinal axis 106 when in an opendeployed configuration.

Specific attention is now directed to FIGS. 4 and 5, which illustrate aclose up view of a multi-stage crest element 116 similar to thosepreviously illustrated in FIGS. 1-3. In FIG. 4, multi-stage crestelement 116 is illustrated in a crimped or compressed configuration. Asmentioned herein, multi-stage crest element 116 would be in a crimped orcompressed configuration, such as that illustrated in FIG. 4, whenendoprosthesis 100 is being delivered or implanted into a patient. FIG.5 illustrates multi-stage crest element 116 in an expanded or deployedconfiguration. Multi-stage crest element 116 would be in the expanded ordeployed configuration illustrated in FIG. 5 when endoprosthesis 100 hasbeen implanted or set within a luminal pathway within a patient.

As is known in the art, an endoprosthesis is typically crimped orcompressed to reduce the radius of the endoprosthesis to facilitateinsertion of the endoprosthesis into the patient and movement thereofthrough the patient's luminal pathways. When crimping or compressing anendoprosthesis, forces are applied which cause the various elements orcomponents of the endoprosthesis to bend or become reoriented in orderto reduce the radius of the endoprosthesis. Once the endoprosthesis hasbeen positioned in the desired location in the patient, theendoprosthesis is expanded into a deployed configuration. When expandingan endoprosthesis to the deployed configuration, forces are appliedwhich cause the various elements or components of the endoprosthesis tobend or become reoriented in order to increase the radius of theendoprosthesis.

Whether during crimping or expansion, the bending and reorientation ofthe various elements or components of an endoprosthesis can causesignificant strains in the elements or components of the endoprosthesis.As will be understood by one skilled in the art, excessive strains cancause elastic spring-back or recoil, structural fatigue, cracking,breaking, deformation, or other undesirable failures in anendoprosthesis. As will also be understood by one skilled in the art,the strains that result from crimping or expanding an endoprosthesistypically occur or are focused in bends, joints, elbows, transitionareas, and the like, since these areas are most likely to compress orstretch to enable the reorientation of the various endoprosthesiscomponents.

Endoprostheses known in the art typically have strut elements, such asadjacent bar arms, connected to one another by way of a crest that has asingle bend, commonly referred to as U-crests or V-crests because thecrests are generally U or V-shaped. As these endoprostheses are crimpedor expanded, the adjacent bar arms are reoriented relative to oneanother. This reorientation causes a relatively significant amount ofstrain to be concentrated in the bends of the U or V-crests.Concentration of strains within the bends of the U or V-crests may leadto elastic recoil, structural fatigue, and even cracking breaking,deformation, or other types of failure.

Other types of crest elements are known in the art and which arereferred to as W-crests. W-crests differ from U and V-crests in thatW-crests connect two adjacent bar arms through two bends. Thus, duringcrimping or expansion, a W-crest can distribute strains through the twobends rather than just one bend as with a U or V-crest. Distributing thestrains through two bends can understandably decrease the strainconcentration experienced at any one given point, which can reduce thelikelihood of failure. Nevertheless, the strains experienced by anendoprosthesis can be large enough that distribution through a dual-bendW-crest may not be sufficient to prevent recoil, fatigue, or failure.

An endoprosthesis according to the present invention reduces thelikelihood of recoil, structural fatigue, cracking, breaking,deformation, or other undesirable failures by distributing the strainsexperienced by the endoprosthesis through several strain regions. Aswill be understood by one of skill in the art, reducing the amount ofstrain experienced at any given point in a body will reduce thelikelihood of damage at that point. Therefore, to reduce the likelihoodof damage at any given point on an endoprosthesis, the amount of strainexperienced at any given point should be limited below a level thatcould cause such damage.

FIG. 4 illustrates tensile and compressive strains that may beexperienced during crimping of endoprosthesis 100. More particularly,FIG. 4 illustrates strains that may result in a multi-stage crestelement 116 as endoprosthesis 100 is crimped or compressed into adelivery configuration. As noted above, strains that result fromdeforming an object (e.g., such as compressing or expanding anendoprosthesis) typically occur or are focused in bends, joints, elbows,transition areas, and the like. Thus, in the illustrated embodiment, thestrains experienced by multi-stage crest element 116 during crimpingoccur primarily in elbows 130, 132, 134, 136, 138. In other words, asendoprosthesis 100 is crimped, the total strain that is experienced byeach multi-stage crest element 116 is distributed primarily among elbows130, 132, 134, 136, 138. Distributing the total strain experienced byeach multi-stage crest element 116 among various points or areas of eachmulti-stage crest element 116 limits the amount of strain that isexperienced at any one given point on each multi-stage crest element116. Thus, for example, rather than having the entire strain beconcentrated in the one or two bends of a V-crest, U-crest, or W-crest,as discussed above, the present embodiment distributes the total strainamong several elbows, thereby limiting the level of strain experiencedby any one of the elbows.

As can be seen in FIG. 4, each of elbows 130, 132, 134, 136, 138 has apair of strains. The pair of strains for each elbow includes acompressive strain and a tensile strain. For instance, transition elbow136 has a strain region 148 and a strain region 150. During crimping, aforce is applied to reduce the diameter of endoprosthesis 100. Thiscompression force will cause second end 114 of bar arm 110 a to pivot,rotate, or otherwise move toward bar arm 110 b in the direction of arrow152. Depending on the magnitude and/or how the compression force isapplied, elbow 130 (with its corresponding link arms 122, 124) may alsopivot, rotate, or otherwise move toward elbow 134 in the direction ofarrow 156. Whether or not elbow 130 moves in the direction of arrow 156,the compression force will cause elbow 136 to deform or straighten,thereby allowing second end 114 of bar arm 110 a to move in thedirection of arrow 152.

The straightening of elbow 136 may alter the orientation or relativepositioning of bar arm 110 a relative to the components of multi-stagecrest element 116. For instance, as elbow 136 straightens, the angleformed between bar arm 110 a and link arm 122 may increase. The angleformed by bar arm 110 a and link arm 122 may increase even more if thecompression force causes elbow 130 (and the end of link arm 122connected thereto) to move in the direction of arrow 156. In addition toaltering the angle between bar arm 110 a and link arm 122, straighteningof elbow 136 may also increase the distance between second end 114 ofbar arm 110 a and elbow 130. In any event, for elbow 136 to straighten,the material in strain region 148 will have to stretch while thematerial in strain region 150 will have to compress.

Notably, strain regions 148, 150 are present in transition elbow 136 asa result of the initial relative orientation between bar arm 110 a andlink arm 122. In some U-crest and W-crest endoprostheses known in theart, the bar arms are connected to the U-crests or W-crests through verywide-open or relatively flat bends. During crimping and expansion, theseflat bends do not open or close significantly. As a result, very littlestrain is distributed through these flat bends, but rather isconcentrated in the bend or bends of the U-crests and W-crests. Incontrast, as discussed above, bar arm 110 a and link arm 122 areoriented relative to one another and connected through transition elbow136 in such a way that during crimping and expansion elbow 136 can openor close enough to distribute a relatively significant amount of strain,thereby reducing the amount of strain that other areas of theendoprosthesis will experience. As a result of this increaseddistribution of the total strain, each area of multi-stage crest element116 will experience less strain and, therefore, will be at lower risk offatigue or failure.

The compression force may also create strains within strain regions 160,162 of elbow 130. These strains may be created as the compression forcecauses link arm 122 to pivot, rotate, or otherwise move relative to linkarm 124. For instance, as shown in FIG. 4, the compression force maycause the end of link arm 122 adjacent elbow 136 to move closer to elbow132 and/or the end of link arm 124 connected thereto. This movement oflink arm 122 may alter the orientation of link arm 122 relative to linkarm 124 so that link arms 122, 124 are no longer substantially parallelto one another. Nevertheless, the compression force may also cause theend of link arm 122 adjacent elbow 130 to move closer to the end of linkarm 124 adjacent elbow 130 so as to generally maintain the substantiallyparallel orientation between link arms 122, 124. In either case, thecompression force will cause elbow 130 to deform or become more curved,thereby altering the orientation or relative positioning of link arm 122relative to link arm 124. In any event, for elbow 130 to deform orbecome more curved, the material in strain region 160 will have tostretch while the material in strain region 162 will have to compress.

As can be seen in FIG. 4, multi-stage crest element 116 is generallysymmetrical across symmetry line AS. As a result of this symmetry,elbows 138, 134 may include strain regions that are generally mirrorimages of strain regions 148, 150 and strain regions 160, 162,respectively, when reflected across symmetry line AS. The strain regionsof elbows 138, 134 will, understandably, experience similar strains aselbows 136, 130, as described above.

With regard to elbow 138, elbow 138 may include strain regions 164, 166that are generally mirror images of strain regions 148, 150,respectively, when reflected across symmetry line AS. That is, as thecompression force is applied, strain region 164 may experience tensilestrains and strain region 166 may experience compressive strains thatenable or cause elbow 138 to deform or straighten. Like the deformationor straightening of elbow 136, the deformation or straightening of elbow138 may cause second end 114 of bar arm 110 b to pivot, rotate, orotherwise move toward bar arm 110 a in the direction of arrow 154.Depending on the magnitude and/or the manner in which the compressionforce is applied, elbow 134 (with its corresponding link arms 126, 128)may also pivot, rotate, or otherwise move toward elbow 130 in thedirection of arrow 158. Whether or not elbow 134 moves in the directionof arrow 158, the compression force will cause elbow 138 to deform orstraighten, thereby allowing second end 114 of bar arm 110 b to move inthe direction of arrow 154.

The straightening of elbow 138 may alter the orientation or relativepositioning of bar arm 110 b relative to the components of multi-stagecrest element 116. For instance, as elbow 138 straightens, the angleformed between bar arm 110 b and link arm 128 may increase. The angleformed by bar arm 110 b and link arm 128 may increase even more if thecompression force causes elbow 134 (and the end of link arm 128connected thereto) to move in the direction of arrow 158. In addition toaltering the angle between bar arm 110 b and link arm 128, straighteningof elbow 138 may also increase the distance between second end 114 ofbar arm 110 b and elbow 134. In any event, for elbow 138 to straighten,the material in strain region 164 will have to stretch while thematerial in strain region 166 will have to compress.

Like strain regions 148, 150 in elbow 136, strain regions 164, 166 arepresent in transition elbow 138 as a result of the initial relativeorientation between bar arm 110 b and link arm 128. Bar arm 110 b andlink arm 128 are oriented relative to one another and connected throughtransition elbow 138 in such a way that during crimping and expansionelbow 138 can open or close enough to distribute a relativelysignificant amount of strain, thereby reducing the amount of strain thatother areas of the endoprosthesis will experience. As a result of thisincreased distribution of the total strain, through both elbow 138 andelbow 136, each area of multi-stage crest element 116 will experienceless strain and, therefore, will be at lower risk of fatigue or failure.

With regard to elbow 134, elbow 134 may include strain regions 168, 170that are generally mirror images of strain regions 160, 162,respectively, when reflected across symmetry line AS. Thus, as thecompression force is applied, strain region 168 may experience tensilestrains and strain region 170 may experience compressive strains thatenable or cause elbow 134 to deform or become more curved. These strainsmay be created as the compression force causes link arm 128 to pivot,rotate, or otherwise move relative to link arm 126. For instance, asshown in FIG. 4, the compression force may cause the end of link arm 128adjacent elbow 138 to move closer to elbow 132 and/or the end of linkarm 126 connected thereto. This movement of link arm 128 may alter theorientation of link arm 128 relative to link arm 126 so that link arms126, 128 are no longer substantially parallel to one another.Nevertheless, the compression force may also cause the end of link arm128 adjacent elbow 134 to move closer to the end of link arm 126adjacent elbow 134 so as to generally maintain the substantiallyparallel orientation between link arms 126, 128. In either case, thecompression force will cause elbow 134 to deform or become more curved,thereby altering the orientation or relative positioning of link arm 128relative to link arm 126. In any event, for elbow 134 to deform orbecome more curved, the material in strain region 168 will have tostretch while the material in strain region 170 will have to compress.

In addition to elbows 130, 134, 136, 138 each having a pair of strainregions, elbow 132 may also have strain regions 172, 174. Unlike thestrain regions of elbows 130, 134, 136, 138, which experience either atensile or compressive strain when a compression force is applied toendoprosthesis 100, each of strain regions 172, 174 may experience atensile strain, a compressive strain, or no strain when a compressionforce is applied to endoprosthesis 100. That is, depending on themagnitude and/or the manner in which the compression force is applied,the type of strain experienced by strain regions 172, 174 may change.

For instance, if the compression force is applied in such a way so as tocause elbows 130, 134 to move in the direction of arrows 156, 158,respectively, then, as illustrated in FIG. 4, strain region 172 willexperience a compressive strain while strain region 174 will experiencea tensile strain. In such a situation, the angle formed by link arms124, 126 will decrease. Movement of elbows 130, 134 in the directions ofarrows 156, 158, respectively, may also alter the distance between elbow136 and elbow 138 and/or the distance between elbows 136, 138 and elbow132.

Depending on how far elbows 130, 134 move in the directions of arrows156, 158, as well as how much the curvature of elbows 130, 134increases, the distance between elbow 136 and elbow 138 may increase,decrease, or stay about the same as the compression force is applied.Similarly, the degree to which elbows 130, 134 move in the directions ofarrows 156, 158, as well as how much the curvature of elbows 130, 134increase, the distance between elbows 136, 138 and elbow 132 mayincrease significantly or only slightly. By way of example, elbows 130,132, 134 may deform, curve, bend, or the like, sufficiently so thatelbows 136, 138 come closer to or into contact with one another and/orelbow 132.

Nevertheless, the compression force may be applied in such a way thatcauses elbows 130, 134 to move, respectively, in directions opposite tothe directions indicated by arrows 156, 158. This may be the case if thecompression force is only applied to bar arms 110 and not to multi-stagecrest elements 116. In such a circumstance, strain region 172 mayexperience a tensile strain while strain region 174 experiences acompressive strain. In such a situation, the angle formed by link arms124, 126 would increase. Movement of elbows 130, 134 in the oppositedirections of arrows 156, 158, respectively, may also alter the distancebetween elbow 136 and elbow 138 and/or the distance between elbows 136,138 and elbow 132.

Depending on how far elbows 130, 134 move in the directions opposite toarrows 156, 158, as well as how much the curvature of elbows 130, 134increase, the distance between elbow 136 and elbow 138 may increase,decrease, or stay about the same as the compression force is applied.Similarly, the degree to which elbows 130, 134 move in the directionsopposite to arrows 156, 158, as well as how much the curvature of elbows130, 134 increases, the distance between elbows 136, 138 and elbow 132may increase significantly or only slightly. By way of example, elbows130, 132, 134 may deform, curve, bend, or the like, sufficiently so thatelbows 136, 138 come into contact with one another and/or elbow 132. Instill other situations, the compression force may be applied such thatstrain regions 172, 174 experience little, if any, strains.

In light of the above discussion, it is clear that multi-stage crestelement 116 is able to distribute through multiple areas the strainexperienced during crimping of endoprosthesis 100. For instance, thestrain that is typically distributed through one or two bends in a U orW-crest can now be distributed through up to five different strainareas. Distributing strain through several strain areas, as opposed toone or two areas, decreases the burden on any one of the strained areasand thus decreases the potential for fatigue or failure.

With attention now to FIG. 5, the strains experienced by endoprosthesis100, and multi-stage crest element 116 particularly, upon expansion areillustrated. Once endoprosthesis 100 has been delivered to the desiredlocation within a patient, endoprosthesis 100 is expanded into thedeployed configuration illustrated in FIG. 3. During expansion, a forceis applied to increase the diameter of endoprosthesis 100. Thisexpansion force will cause the various components of each annular ring102 to undergo various changes. These changes may include beingreoriented, repositioned, compressed, and/or stretched. The followingdescription of FIG. 5 and the changes that the components of annularring 102 experience during expansion are exemplary only. The componentsof annular ring 102 may undergo other changes in addition to ordifferent from those shown and described. Furthermore, the illustratedand described extent of the changes is not intended to be limiting inany way. For instance, the changes experienced by the components ofannular ring 102 may be to a greater or lesser extent than those shownand described.

As shown in FIG. 5, bar arms 110 a, 110 b, link arms 122, 124, 126, 128,and elbows 130, 132, 134, 136, 138 are reoriented, repositioned, and/orexperience compressive and/or tensile strains when an expansion force isapplied to expand endoprosthesis 100. The following discussion willdescribed one exemplary combination of reorientations, repositioning,and strains that bar arms 100 a, 110 b, link arms 122, 124, 126, 128,and elbows 130, 132, 134, 136, 138 undergo during expansion of annularring 102. In describing these reorientations, repositioning, andstrains, the following description will begin in the middle ofmulti-stage crest element 116 (e.g., near elbow 132) and work outward.It will be understood, however, that the expansion of annular ring 102may not begin in or work out from the middle of multi-stage crestelement 116. Rather, the expansion of annular ring 102 may begin inother areas or may be generally uniform such there is not a specificarea on annular ring 102 that begins to expand before another area.

When a radially expanding force is applied to annular ring 102, theforce may cause link arms 124, 126 to be reoriented and/or repositionedrelative to one another to facilitate an increase in the diameter andcircumference of annular ring 102. When in a crimped configuration, asshown in FIG. 4, link arms 124, 126 form an acute angle. Upon expansionof annular ring 102, link arms 124, 126 can be reoriented relative toone another so as to increase the angle formed therebetween. That is,the end of link arm 124 adjacent elbow 130 moves in the direction ofarrow 176 while the end of link arm 126 adjacent elbow 134 moves in thedirection of arrow 178. In the embodiment illustrated in FIG. 5, linkarms 124, 126 are reoriented so as to form an obtuse angle. Byincreasing the angle between link arms 124, 126, link arms 124, 126 liemore in line with the circumference of annular ring 102, the directionof which is indicated by circumferential directionality arrow 108.Aligning link arms 124, 126 more closely with the circumference ofannular ring 102 will, understandably, contribute to increasing thecircumference and diameter of annular ring 102.

In light of the compressive and tensile strains discussed above, it willbe recognized that elbow 132 will experience compressive and tensilestrains when link arms 124, 126 are reoriented upon expansion of annularring 102. However, the compressive and tensile strains that elbow 132will experience upon expansion will be opposite to the compressive andtensile strains experienced upon crimping. More specifically, whilestrain region 172 experiences a compressive strain during crimping,strain region 172 experiences a tensile strain upon expansion. That is,the material in strain region 172 will need to expand to enable linkarms 124, 126 to be reoriented to make them more in line with thecircumference of annular ring 102. Similarly, while strain region 174experiences a tensile strain during crimping, strain region 174experiences a compressive strain upon expansion. Opposite to thematerial in strain region 172, the material in strain region 174 willneed to compress to enable link arms 124, 126 to be reoriented to makethem more in line with the circumference of annular ring 102.

The radial expansion of annular ring 102 will also cause link arm 122 tobe reoriented relative to link arm 124 in order to increase thecircumference and diameter of annular ring 102. As noted above, theexpansion force causes link arm 124 to be reoriented so that it is morein line with the circumference of annular ring 102. Similarly, link arm122 is also reoriented from its crimped orientation. When in a crimpedorientation, as seen in FIG. 4, the end of link arm 122 adjacent elbow130 is further away from symmetry line AS than the end of link arm 122adjacent transition elbow 136. Upon expansion, link arm 122 isreoriented in the direction of arrow 180 so that the end of link arm 122adjacent transition elbow 136 is further away from symmetry line AS thanwhen in the crimped orientation.

In the illustrated expanded arrangement, the end of link arm 122adjacent transition elbow 136 is further away from symmetry line AS thanthe end of link arm 122 adjacent elbow 130. In other embodiments,however, the end of link arm 122 adjacent transition elbow 136 can becloser to or the same distance from symmetry line AS as the end of linkarm 122 adjacent elbow 130. In any case, the reorientation of link arm122 can cause a significant increase in the circumference of annularring 102. In the illustrated expanded arrangement, link arms 122, 124form a generally right angle. Nevertheless, link arms 122, 124 may alsoform an acute angle or an obtuse angle when annular ring 102 isexpanded.

Just as elbow 132 experiences compressive and tensile strains uponexpansion of annular ring 102, so too does elbow 130. Also like elbow132, the compressive and tensile strains that elbow 130 experiences uponexpansion are opposite to the compressive and tensile strainsexperienced upon crimping. More specifically, while strain region 160experiences a tensile strain during crimping, strain region 160experiences a compressive strain upon expansion. That is, the materialin strain region 160 will need to compress to enable link arm 122 to bereoriented relative to link arm 124 as shown in FIG. 5. Similarly, whilestrain region 162 experiences a compressive strain during crimping,strain region 162 experiences a tensile strain upon expansion. Oppositeto the material in strain region 160, the material in strain region 162will need to stretch to enable link arm 122 to be reoriented relative tolink arm 124, as shown in FIG. 5.

As noted above, multi-stage crest element 116 is generally symmetricalacross symmetry line AS. Thus, the reorientation and strains of link arm126, elbow 134, and link arm 128 are generally mirror images of thereorientation and strains of link arm 124, elbow 130, and link arm 122,respectively. More specifically, like link arm 122, expansion of annularring 102 causes link arm 128 to be reoriented in the direction of arrow182 from it crimped orientation shown in FIG. 4 to its expandedorientation shown in FIG. 5. In its crimped orientation, the end of linkarm 128 adjacent transition elbow 138 is closer to symmetry line AS thanthe end of link arm 128 adjacent elbow 134. In contrast, when expanded,the end of link arm 128 adjacent transition elbow 138 is further awayfrom symmetry line AS. In some embodiments, even in an expandedorientation, the end of link arm 128 adjacent elbow 138 remains closerto symmetry line AS than the end of link arm 128 adjacent elbow 134. Inother embodiments, such as the illustrated embodiment, the end of linkarm 128 adjacent elbow 138 is at least as far or further away fromsymmetry line AS as the end of link arm 128 adjacent elbow 134. In anycase, the reorientation of link arm 128 can cause a significant increasein the circumference of annular ring 102. In the illustrated expandedarrangement, link arms 126, 128 form a generally right angle.Nevertheless, link arms 126, 128 may also form an acute angle or anobtuse angle when annular ring 102 is expanded.

Just as with elbow 130, the reorientation of link arm 128 relative tolink arm 126 causes strains in elbow 134. The strains experienced byelbow 134 are mirror images of the strains experienced by elbow 130 andare opposite to the strains elbow 134 experiences during crimping. Thus,the material in strain region 168 is compressed or experiences acompressive strain and the material in strain region 170 is stretched orexperiences a tensile strain when annular ring 102 is expanded.

Upon expansion of annular ring 102, bar arms 110 a, 110 b are alsoreoriented relative to the link arms to which they are connected as wellas to one another. With specific reference to bar arm 110 a, expansionof annular ring 102 causes bar arm 110 a to be reoriented relative tolink arm 122. More specifically, second end 114 of bar arm 110 a movesin the direction of arrow 184 so as to orient bar arm 110 a generallyparallel with the circumference of annular ring 102, as indicated bycircumferential directionality arrow 108. Reorienting bar arm 110 a tothe illustrated expanded position may be accomplished, at least in part,by increasing the angle formed by bar arm 110 a and link arm 122. As theangle between bar arm 110 a and link arm 122 increases, the distancebetween second end 114 of bar arm 110 a and elbow 130 will alsoincrease.

As the angle between bar arm 110 a and link arm 122 increases duringexpansion of annular ring 102, transition elbow 136 also experiencestensile and compressive strains. In order to enable the reorientation ofbar arm 110 a as described, the material in strain region 148 muststretch or experience a tensile strain while the material in strainregion 150 must compress or experience a compressive strain. Notably,the strains experienced by transition elbow 136 are different from thoseexperienced by elbows 130, 134. As discussed above, the strain regionsof elbows 130, 134 experience different types of strains depending onwhether annular ring 102 is crimping or expanded. By way of example,strain region 160 of elbow 130 experiences a tensile strain duringcrimping and a compressive strain during expansion. In contrast, strainregions 148, 150 of transition elbow 136 experience the same type ofstrain regardless of whether annular ring 102 is crimped or expanded.Thus, strain region 148 experiences a tensile strain when endoprosthesis100 is crimped and when endoprosthesis 100 is expanded. Likewise, strainregion 150 experiences a compressive strain when endoprosthesis 100 iscrimped and when endoprosthesis 100 is expanded.

Bar arm 110 b is reoriented in a similar fashion as bar arm 110 a whenannular ring 102 is expanded. In particular, bar arm 110 b is reorientedrelative to link arm 128 by moving second end 114 in the direction ofarrow 186 so as to orient bar arm 110 b generally parallel with thecircumference of annular ring 102, as indicated by circumferentialdirectionality arrow 108. Reorienting bar arm 110 b to the illustratedexpanded position may be accomplished, at least in part, by increasingthe angle formed by bar arm 110 b and link arm 128. As the angle betweenbar arm 110 b and link arm 128 increases, the distance between secondend 114 of bar arm 110 b and elbow 134 will also increase.

Increasing the angle between bar arm 110 b and link arm 128 duringexpansion of annular ring 102 will also cause transition elbow 138 toexperience tensile and compressive strains similar to those experiencedby transition elbow 136. Specifically, to enable the reorientation ofbar arm 110 b as described, the material in strain region 164 muststretch or experience a tensile strain while the material in strainregion 166 must compress or experience a compressive strain. As with thestrains experienced by strain regions 148, 150, the strains experiencedby strain regions 164, 166 are the same type regardless of whetherannular ring 102 is crimped or expanded.

As a result of the above described configuration of annular ring 102 andthe reorientation possibilities thereof, annular ring 102 can beexpanded such that bar arm 110 a, elbow 136, link arm 122, elbow 130,and link arm 124 as a unit generally move in the direction of arrow 188and link arm 126, elbow 134, link arm 128, elbow 138, and bar arm 110 bas a unit generally move in the direction of arrow 190. The overallreorientation of the components of annular ring 102 upon expansion canarrange annular ring 102 into a generally vertical column or morecolumn-like structure (when viewing annular ring in a plane), as shownin FIGS. 3 and 5. In addition, the inclusion of the various elbows inmulti-stage crest element 116 spreads or distributes the strainsexperienced during crimping or expansion so that any one given point orarea will not experience strains at a level that could causedeformation, cracking, breaking, fatigue, or other failures.Distributing the strains and creating a more column-like structure uponexpansion improves the radial strength of the device.

More specifically, by obliquely orienting link arms 122, 128 relative toa longitudinal axis of annular ring 122 (e.g., circumferentiallyoffsetting the ends of link arm 122 from one another andcircumferentially offsetting the ends of link arm 128 from one another),each multi-stage crest element 116 includes at least two additionalelbows or bends where significant amounts of strain can be distributedas compared to known U and W-crests. That is, for example, while aprevious W-crest has two strain-distributing bends, the multi-stagecrest element of the present invention includes at least four or fivestrain-distributing elbows or bends. As a result, the strain that wouldhave been distributed through the two bends of a previous W-crest cannow be distributed through four or five strain distributing bends.

As discussed above, by distributing the strains through more areas in anendoprosthesis, the amount of strain experienced at any one givenlocation will be limited. Limiting the amount of strain experienced at agiven location reduces the likelihood that that location will experiencestructural fatigue or failure or will cause elastic recoil.

Attention is now directed to FIGS. 6-10, which illustrate anendoprosthesis 200 according to another exemplary embodiment of thepresent invention. As can be seen in FIGS. 6-10, endoprosthesis 200 issimilar to endoprosthesis 100 in many respects. Due to the manysimilarities between endoprosthesis 100 and endoprosthesis 200, thecomponents of endoprosthesis 200 that are identical to or generally thesame as corresponding components from endoprosthesis 100 will only bebriefly mentioned in the following description. Thus, the followingdiscussion will focus primarily on the components of endoprosthesis 200that are different from endoprosthesis 100. Nevertheless, if additionaldetails or information is desired regarding the components ofendoprosthesis 200 which are only briefly mentioned below, reference canbe made to the above descriptions of the corresponding components fromendoprosthesis 100. Components of endoprosthesis 200 which correspond tocomponents from endoprosthesis 100 are identified with similar referencenumbers that have been incremented by 100.

With reference to FIG. 6, a side view of a flattened portion (i.e.,planar view) of endoprosthesis 200 is illustrated. In the illustratedembodiment, endoprosthesis 200 includes a plurality of annular rings202, but can include one or more annular rings 202. Each annular ring202 can include a set of interconnected bar arms 210, which are disposedcircumferentially about longitudinal axis 206. Arrows 208 illustratesthe circumferential directionality. Each bar arm 210 has a first end 212and a second end 214. First ends 212 of bar arms 210 interconnect tomulti-stage crest elements 216 that are proximate to a firstlongitudinal side 218 of the annular ring 202 of which the elements area part. Similarly, second ends 214 of bar arms 210 interconnect tomulti-stage crest elements 216 that are proximate to a secondlongitudinal side 220 of the annular ring 202. Thus, bar arms 210 can belinked to one another through multi-stage crest elements 216, therebyforming a generally zigzag-type pattern.

Like multi-stage crest elements 116, multi-stage crest elements 216 mayprovide the illustrated endoprosthesis 200 with numerous benefits. Forinstance, multi-stage crest elements 216 may distribute through severalstrain distributing areas the strains experienced by endoprosthesis 200during crimp, expansion, and use. This distribution of strains canimprove the structural integrity and performance of endoprosthesis 200by limiting the strain at any given point on endoprosthesis 200 to alevel that is unlikely to cause fatigue, distortion, cracking, or othertype of potential failure. Further, the arrangement of the components ofmulti-stage crest elements 216 and the resulting improved straindistribution can limit the amount of elastic spring-back or recoilobserved as endoprosthesis 200 is crimped or expanded. Moreover,multi-stage crest elements 216 also enable more uniform crimping andexpansion of annular rings 202. Still further, the arrangement ofmulti-stage crest element 216 components relative to one another andadjacent bar arms 210 limits the amount of force required to crimp orexpand each annular ring 202. This arrangement also improves the radialstrength of annular rings 202.

Each multi-stage crest element 216 can include multiple link arms,elbows, joints, crests, valleys, connectors, combinations thereof, orthe like. As shown in FIGS. 6-10, the exemplary illustrated embodimentof multi-stage crest element 216 includes link arms 222, 224, 226, 228connected together via elbows 230, 232, 234. Multi-stage crest element216 also includes transition elbows 236, 238 for connecting ortransitioning multi-stage crest element 216 tocircumferentially-adjacent bar arms 210, such as bar arms 210 a, 210 b.Bar arms 210, link arms 222, 224, 226, 228, elbows 230, 232, 234, 236,238 correspond to, have similar or identical configurations as, and/orperform the same function as bar arms 110, link arms 122, 124, 126, 128,elbows 130, 132, 134, 136, 138 discussed above with regard toendoprosthesis 100. Thus, the description of bar arms 110, link arms122, 124, 126, 128, elbows 130, 132, 134, 136, 138 is germane to bararms 210, link arms 222, 224, 226, 228, elbows 230, 232, 234, 236, 238.

In contrast to multi-stage crest element 116, multi-stage crest element216 also includes link arms 225, 227 and elbow 233. An end of link arm225 is connected to the end of link arm 224 adjacent elbow 230 and/or toa portion of elbow 230 adjacent link arm 224. The other end of link arm225 is connected to elbow 233. An end of link arm 227 is connected tothe end of link arm 226 adjacent elbow 234 and/or to a portion of elbow234 adjacent link arm 226. The other end of link arm 227 is connected toelbow 233. In this configuration, link arms 224, 225, 226, 227 arelinked end to end so as to form a hollow arrangement with an opening 229therethrough. In the illustrated embodiment, opening 229 is generallydiamond shaped.

As seen in FIGS. 6-8, each annular ring 202 can be formed with agenerally uniform and/or alternating pattern. For instance, just asfirst ends 212 of circumferentially-adjacent bar arms 210 are connectedtogether via a multi-stage crest element 216, so too are second ends 214of circumferentially-adjacent bar arms 210 connected together via amulti-stage crest element 216.

As can also be seen in FIG. 6, while the multi-stage crest elements 216disposed along second longitudinal side 220 of annular ring 202 a arecircumferentially offset from the multi-stage crest elements 216disposed along first longitudinal side 218 of annular ring 202 a,multi-stage crest elements 216 disposed along second longitudinal side220 of annular ring 202 a are substantially mirror images of multi-stagecrest elements 216 disposed along first longitudinal side 218 of annularring 202 a. In other words, if multi-stage crest element 216 a wererotated about radial axis 240 (which extends radially from longitudinalaxis 206 through a midpoint of bar arm 210 a), multi-stage crest element216 a would lie in and fill the same space as multi-stage crest element216 b. Likewise, if multi-stage crest element 216 b were rotated aboutradial axis 240, multi-stage crest element 216 b would lie in and fillthe same space as multi-stage crest element 216 a.

As discussed above in connection with endoprosthesis 100, each annularring 202 can be crimped or compressed to a delivery configuration asshown in FIG. 7 by altering the angles of elbows 230, 232, 233, 234,236, 238 of multi-stage crest elements 216 and/or the angles between thecircumferentially-adjacent bar arms 210. Also,circumferentially-adjacent multi-stage crest elements 216 on each side218, 220 of annular ring 202 can be spaced apart by a circumferentialdistance D, such that each annular ring 202 is crimped by decreasing thedistance D between circumferentially-adjacent multi-stage crest elements216. Correspondingly, each annular ring 202 can be expanded to adeployed configuration as shown in FIG. 8 by altering the angles ofelbows 230, 232, 233, 234, 236, 238 of multi-stage crest elements 216and/or the angles of between the circumferentially-adjacent bar arms210. Also, annular ring 202 can be expanded by increasing the distance Dbetween circumferentially-adjacent multi-stage crest elements 216. Atany given condition between the delivery configuration and the deployedconfiguration, the distance D can be balanced or constant from onecircumferentially-adjacent multi-stage crest element 216 to the next, orcan be varied if desired.

In the illustrated embodiment of endoprosthesis 200, a plurality ofconnectors 204 are provided to connect adjacent annular rings 202 a-d.Each connector 204 includes a first end 242, a second end 244, and anintermediate portion 246. In the illustrated embodiment, first end 242connects to a multi-stage crest element 216 on one of annular rings 202a-d and second end 244 connects to a multi-stage element 216 on anadjacent annular ring. According to the illustrated embodiment, firstend 242 of connector 104 connects to an outer surface of elbow 232(e.g., at what would otherwise be a peak of elbow 232) while second end244 connects to an outer surface of elbow 233 (e.g., at what wouldotherwise be a peak of elbow 233) of a multi-stage crest element 216 onan adjacent annular ring. Corresponding multi-stage crest elements 216on adjacent annular rings 202 (e.g., multi-stage crest elements 216 thatare connected together via a connector 204) open in the same direction.

As shown in FIGS. 6-8, intermediate portion 246 of connector 204 has ageneral U-shape. In other embodiments, intermediate portion can includeother shapes, including curves, straight segments, angles, bends,combinations thereof, and the like to suit a particular need or desire.Forming intermediate portion 246 with curves, bends, angles, and thelike can provide some versatility and flexibility to endoprosthesis 200.By way of example, inclusion of such features can enable endoprosthesisto bend more easily as it is passed through a tortuous luminal pathway.Additionally, the inclusion of bends, curves, angles, and the like canalso facilitate longitudinal expansion or contraction of endoprosthesiswith minimal risk of connector 204 fatiguing, cracking, breaking, orotherwise failing.

As illustrated, not all of the multi-stage crest elements 216 need to beconnected to a connector 204. Rather, the number and spacing betweenconnectors 204 can be adjusted based on the particular need associatedwith the endoprosthesis. For instance, adjacent annular rings 202 can beconnected with as few as one connector 204, or can include numerousconnectors 204. Additionally, connectors 204 can be connected to annularrings 202 at various locations. For instance, connectors 204 can connectto bar arms, elbows, link arms, any combination thereof, and the like.Additionally, the connectors 204 need not extend parallel to thelongitudinal axis 206, but can be aligned diagonally or helically suchthat ends 242, 244 of connectors 204 are circumferentially offset.

For simplicity and clarity, each bar arm 210 and link arm 222, 224, 225,226, 227, 228 depicted in FIGS. 6-10 is shown to be a straight member.It is recognized, however, that the bar arms 210 and link arms 222, 224,225, 226, 227, 228 can be contoured, shaped, or sized to increaseflexibility if desired. Additionally, each bar arm 210 of the annularring 202 can be a straight member or have various curves or shapessimilar to the connectors 204. When in a closed delivery configuration,bar arms 210 can be oriented to be oblique to longitudinal axis 206, aswell as with each other, as shown in FIG. 6. When in an open deployedconfiguration, multi-stage crest elements 216 can be expanded and bararms 210 can be oriented generally perpendicular to longitudinal axis206, as shown in FIG. 8, so that each annular ring 202 forms (whenviewed in a plane) a generally vertical column or more column-likestructure. Such a configuration provides enhanced radial strength to theannular rings 202. Nevertheless, in an alternative embodiment, bar arms210 can be oriented generally oblique to longitudinal axis 206 when inan open deployed configuration.

Specific attention is now directed to FIGS. 9 and 10, which illustrate aclose up view of a multi-stage crest element 216 similar to thosepreviously illustrated in FIGS. 6-8. In FIG. 9, multi-stage crestelement 216 is illustrated in a crimped or compressed configuration. Asmentioned herein, multi-stage crest element 216 would be in a crimped orcompressed configuration, such as that illustrated in FIG. 9, whenendoprosthesis 200 is being delivered or implanted into a patient. FIG.10 illustrates multi-stage crest element 216 in an expanded or deployedconfiguration. Multi-stage crest element 216 would be in the expanded ordeployed configuration illustrated in FIG. 10 when endoprosthesis 200has been implanted or set within a luminal pathway within a patient.

As discussed herein, crimping and expanding an endoprosthesis can causethe endoprosthesis to experience various strains, including compressiveand tensile strains, which can cause structural fatigue, cracking,breaking, deformation, or other undesirable failures in theendoprosthesis. As with endoprosthesis 100, endoprosthesis 200 isconfigured to distribute these strains to reduce the likelihood ofstructural fatigue, cracking, breaking, deformation, or otherundesirable failures. FIG. 9 illustrates tensile and compressive strainsthat may be experienced during crimping of endoprosthesis 200. Moreparticularly, FIG. 9 illustrates strains that may result in amulti-stage crest element 216 as endoprosthesis 200 is crimped orcompressed into a delivery configuration.

During crimping of endoprosthesis 200, elbows 230, 232, 234, 236, 238will experience strains similar to those described above with referenceto elbows 130, 132, 134, 136, 138, respectively. Each of elbows 230,232, 234, 236, 238 will have a pair of strain regions that experienceopposing compressive and tensile strains. In contrast to endoprosthesis100, which has five elbows through which to distribute the total strain,the inclusion of link arms 225, 227 and elbow 233 creates additionalareas through which the strains can be distributed.

As can be seen in FIG. 9, as endoprosthesis 200 is crimped, the angleformed by link arms 224, 226 decreases and the angle formed by link arms225, 227 decreases. Correspondingly, the angle formed between link arms224, 225 increases and the angle formed between link arms 226, 227increases as endoprosthesis 200 is crimped. The reorientation of linkarms 224, 225, 226, 227 relative to one another longitudinally lengthensout and vertically shortens the generally diamond shaped opening 229formed by these link arms.

The above-described reorientations of link arms 224, 225, 226, 227 alsocause compressive and tensile strains. As can be seen, elbow 232includes two strain regions 272, 274 and elbow 233 includes two strainregions 235, 237. Some of the strain created by crimping endoprosthesis200 is distributed through strain regions 235, 237, 272, 274. Thestrains experienced by strain regions 272, 274 are similar to theabove-discussed strains experienced by strain regions 172, 174, exceptthat the magnitude of the strains experienced by strain regions 272, 274may be less than those experienced by strain regions 172, 174.

As can be seen in the Figures, link arms 225, 227 and elbow 233 aresubstantially mirror images of link arms 224, 226 and elbow 232. Due tothe symmetrical nature of these components, strain regions 235, 237 canalso experience similar strains as strain regions 272, 274. In additionto distributing some of the total strain through elbow 233, some of thestrain will also be distributed through the areas where link arm 225connects to link arm 224 and/or elbow 230 and where link arm 227connects to link arm 226 and/or elbow 234. These areas, identified asstrain regions 239, 241, will experience a tensile strain asendoprosthesis 200 is crimped. That is, as the angles between link arms224, 225 and link arms 226, 227 increase, the material in strain regions239, 241 will need to stretch to allow for the reorientation of linkarms 224, 225 and link arms 226, 227

When endoprosthesis 200 is expanded, bar arms 210 and multi-stage crestelements 226 will be reoriented as shown in FIG. 10. The reorientationof link arms 224, 225, 226, 227 relative to one another during expansioncan cause the generally diamond shaped opening 229 formed by link arms224, 225, 226, 227 to longitudinally shorten and vertically lengthen asshown in FIG. 10. This reconfiguration will cause strain regions 235,237, 239, 241, 272, 274 to experience strains that are different fromthose experienced during crimping. For instance, while strain regions235, 272 experienced compressive strains during crimping, strain regions235, 272 experience tensile strains during expansion of endoprosthesis200. Likewise, strain regions 237, 239, 241, 274 experience compressivestrains during expansion and tensile strains during crimping ofendoprosthesis 200.

The overall reorientation of the components of annular ring 202 uponexpansion can arrange annular ring 202 into a generally vertical columnor more column-like structure (when viewing annular ring in a plane). Inaddition, the inclusion of the various elbows in multi-stage crestelement 216 spreads or distributes the strains experienced duringcrimping or expansion so that any one given point or area will notexperience strains at a level that could cause deformation, cracking,breaking, fatigue, or other potential failures. Distributing the strainsand creating a more column-like structure upon expansion improves theradial strength of the device.

More specifically, by obliquely orienting link arms 222, 228 relative toa longitudinal axis of annular ring 222 (e.g., circumferentiallyoffsetting the ends of link arm 222 from one another andcircumferentially offsetting the ends of link arm 228 from one another),and adding link arms 225, 227 and elbow 233, each multi-stage crestelement 216 includes at least five or six additional elbows, bends, orareas where significant amounts of strain can be distributed as comparedto known U and W-crests. That is, for example, while a previous W-cresthas two strain-distributing bends, the multi-stage crest element 216 ofthe present invention includes at least seven or eightstrain-distributing elbows, bends, or areas. As a result, the strainthat would have been distributed through the two bends of a previousW-crest can now be distributed through seven or eight straindistributing bends or areas.

As discussed above, by distributing the strains through more areas in anendoprosthesis, the amount of strain experienced at any one givenlocation will be limited. Limiting the amount of strain experienced at agiven location reduces the likelihood that that location will experiencestructural fatigue or failure or will cause elastic recoil.

In light of the above-described embodiments, it will be appreciated thatan annular ring of an endoprosthesis can be formed with multiple bararms connected together with one or more multi-stage crest elements.Each of the multi-stage crest elements can include multiple link armsand elbows. The elbows can create multiple regions in which the strainsexperienced during crimping and expansion of the annular ring can bedistributed. The multi-stage crest element can includes, for example,five or six elbows that can be considered strain regions. Each of theseelbows or strain regions can include a pair of opposite strains. Forinstance, each elbow or strain region can include a tensile strainregion and a compressive strain region. In some circumstances, thetensile strain regions and the compressive strain regions can changedepending on whether the annular ring is being crimped or expanded. Inother cases, the tensile strain regions and the compressive strainregions remain the same regardless of whether the annular ring is beingcrimped or expanded.

The above described and illustrated embodiments provide a number ofbeneficial features. For instance, limiting the amount of strainexperienced at any given point on annular ring provides resistance todistortion, fracture, fatigue, or other potential failures. Furthermore,distributing the strain over several areas provides for less elasticspring-back or recoil during crimping or expansion. The arrangement ofthe annular ring components as well as the improved strain distributionalso leads to more even crimping and expansion of the annular ring.

Although not specifically shown, alternative shapes can be used inaddition to or in lieu of the straight bar arms and/or connectors, suchas L-shaped, U-shaped or V-shaped bar arms and/or connectors or the likeas is known in the art. The elbows, link arms, bar arms, and the likecan also have shapes other than those which are illustrated. The numberof bar arms, multi-stage crest elements, connectors, and other strutelements included in each annular ring can depend upon the size anddesired characteristics of the endoprosthesis. For example, a greaternumber of bar arms, multi-stage crest elements, connectors, and/or otherstrut elements can be provided for increased surface-area coverage ofthe luminal wall by the endoprosthesis or increased cross-sectionalprofile of the endoprosthesis in the deployed configuration.

Similarly, the radial bias, rigidity, flexibility, crack resistance,fatigue resistance, and like physical characteristics of each annularring can be controlled or varied by altering the shape or size of thebar arms, multi-stage crest elements, connectors, and the like. Thephysical characteristics of an annular ring, when deployed, generallycan be increased by decreasing the length or by modifying thecross-sectional profile of selected strut elements of the annular ring.For example, it can be possible to provide an endoprosthesis havingvaried radial bias or rigidity along its length by providing one annularring with a radial bias or rigidity that is different from the radialbias or rigidity of another annular ring as is well known in the art. Ina similar manner, it is possible to provide an endoprosthesis having atapered or flare shape formed of adjacent annular rings having differentcross-sectional profiles when in the deployed configuration, but havinga similar or uniform radial bias or rigidity along its length.

The endoprostheses of the present invention can be made of a variety ofmaterials, which are well known in the art of endoprosthesismanufacturing. The material of construction can be selected according tothe structural performance and biological characteristics that aredesired. For example, an endoprosthesis of the present invention can bemade to be expanded by the change of a delivery condition, such as bythe removal of a restraint or exposure to the environment within thebody lumen so as to be self expanding, or by the application of anexternal force or energy, such as by a balloon or by a radio frequency.For purpose of illustration and not limitation, reference is madegenerally to “self-expanding” embodiments and “balloon expandable”embodiments of the endoprosthesis of the present invention.

Self-expanding embodiments of an endoprosthesis can be made from any ofa variety of known suitable materials, such as a shaped memory material(“SMM”). For example, the SMM can be shaped in a manner that allows forrestriction to induce a substantially tubular, linear orientation whilewithin a delivery shaft, but can automatically retain the memory shapeof the endoprosthesis once extended from the delivery shaft. SMMs have ashape memory effect in which they can be made to remember a particularshape. Once a shape has been remembered, the SMM may be bent out ofshape or deformed and then returned to its original shape by unloadingfrom strain or by heating. Typically, SMMs can be shape memory alloys(“SMA”) comprised of metal alloys, or shape memory plastics (“SMP”)comprised of polymers.

Usually, an SMA can have any non-characteristic initial shape that canthen be configured into a memory shape by heating the SMA and conformingthe SMA into the desired memory shape. After the SMA is cooled, thedesired memory shape can be retained. This allows for the SMA to bebent, straightened, compacted, and placed into various contortions bythe application of requisite forces; however, after the forces arereleased the SMA can be capable of returning to the memory shape. Themain types of SMAs are as follows: copper-zinc-aluminium;copper-aluminium-nickel; nickel-titanium (“NiTi”), alloys known asnitinol; and cobalt-chromium-nickel alloys orcobalt-chromium-nickel-molybdenum alloys known as elgiloy. However,other types of SMAs can be used. Typically, the nitinol and elgiloyalloys can be more biocompatible and have superior mechanicalcharacteristics in comparison with the copper-based SMAs. Thetemperatures at which the SMA changes its crystallographic structure arecharacteristic of the alloy, and can be tuned by varying the elementalratios.

For example, it can be preferable for the primary material of anendoprosthesis to be comprised of a Ni—Ti alloy that forms superelasticnitinol. In the present case, nitinol materials can be trained toremember a certain shape, arranged in a shaft, catheter, or other tube,and then released from the catheter or tube to return to its trainedshape. Also, additional materials can be added to the nitinol dependingon the desired characteristic.

An SMP is a shape-shifting plastic that can be fashioned into anendoprosthesis in accordance with the present invention. When an SMPencounters a temperature above the lowest melting point of theindividual polymers, the blend can make a transition to a rubbery state.The elastic modulus can change more than two orders of magnitude acrossthe transition temperature (“Ttr”). As such, an SMP can be formed into adesired shape of an endoprosthesis by heating it above the Ttr, fixingthe SMP into the new shape, and cooling the material below Ttr. The SMPcan then be arranged into a temporary shape by force, and then resumethe memory shape once the force has been applied. Examples of SMPsinclude biodegradable polymers, such as oligo(ε-caprolactone)diol,oligo(ρ-dioxanone)diol, and non-biodegradable polymers such as,polynorborene, polyisoprene, styrene butadiene, polyurethane-basedmaterials, vinyl acetate-polyester-based compounds, and others yet to bedetermined. As such, any SMP can be used in accordance with the presentinvention.

For example, Veriflex™, the trade name for CRG's family of shape memorypolymer resin systems, currently functions on thermal activation thatcan be customizable from −20° F. to 520° F., which allows forcustomization within the normal body temperature. This allows anendoprosthesis comprised of Veriflex™ to be inserted into a deliverycatheter. Once unrestrained by the delivery catheter, the bodytemperature can cause the endoprosthesis to spontaneously take itsfunctional shape.

An endoprosthesis made of a SMM or suitable superelastic material can becompressed or restrained in its delivery configuration on a deliverydevice using a sheath or similar restraint, and then deployed to itsdeployed configuration at a desired location by removal of the restraintas is known in the art. An endoprosthesis made of a thermally sensitivematerial can be deployed by exposure of the endoprosthesis to asufficient temperature to facilitate expansion as is known in the art.

Balloon expandable endoprostheses embodiments can be made of any of avariety of known suitable deformable materials, including stainlesssteel, silver, platinum, cobalt-chromium alloys, or other knownbiocompatible materials

For delivery, the balloon-expandable endoprosthesis of a suitablematerial can be mounted in the delivery configuration on a balloon orsimilar expandable member of a delivery device. Once properly positionedwithin the body lumen at a desired location, the expandable member, suchas a balloon, can be expanded to expand the endoprosthesis to itsdeployed configuration as is known in the art.

Also, balloon expandable endoprostheses embodiments can be made ofsuitable biocompatible polymers in addition to or in place of a suitablemetal or alloy. The polymeric endoprostheses can include biodegradableor bioabsorbable materials, which can be either plastically deformableor capable of being set in the deployed configuration. If plasticallydeformable, the material can be selected to allow the endoprosthesis tobe expanded in a similar manner using an expandable member so as to havesufficient radial strength and scaffolding and also to minimize recoilonce expanded. If the polymer must be set in the deployed configuration,the expandable member can be provided with a heat source or infusionports to provide the required catalyst to set or cure the polymer.Alternatively, known delivery devices and techniques for aself-expanding endoprosthesis likewise can be used.

Additionally, an embodiment of an endoprosthesis can be comprised of abiocompatible material capable of expansion upon exposure to theenvironment within the body lumen forces, or other well-known means forexpansion. Examples of such biocompatible materials can include asuitable hydrogel, hydrophilic polymer, biodegradable polymers,bioabsorbable polymers. Examples of such polymers can includepoly(alpha-hydroxy esters), polylactic acids, polylactides,poly-L-lactide, poly-DL-lactide, poly-L-lactide-co-DL-lactide,polyglycolic acids, polyglycolide, polylactic-co-glycolic acids,polyglycolide-co-lactide, polyglycolide-co-DL-lactide,polyglycolide-co-L-lactide, polyanhydrides, polyanhydride-co-imides,polyesters, polyorthoesters, polycaprolactones, polyesters,polyanydrides, polyphosphazenes, polyester amides, polyester urethanes,polycarbonates, polytrimethylene carbonates,polyglycolide-co-trimethylene carbonates, poly(PBA-carbonates),polyfumarates, polypropylene fumarate, poly(p-dioxanone),polyhydroxyalkanoates, polyamino acids, poly-L-tyrosines,poly(beta-hydroxybutyrate), polyhydroxybutyrate-hydroxyvaleric acids,combinations thereof, or the like. For example, a self-expandableendoprosthesis can be delivered to the desired location in an isolatedstate, and then exposed to the aqueous environment of the body lumen tofacilitate expansion.

Additionally, other well-known delivery devices and techniques for aself-expanding endoprosthesis can be used. For example, prior tocrimping of the self-expanding endoprosthesis for loading into adelivery system, the endoprosthesis may be coated with a lubricant suchas silicone oil to reduce force between the endoprosthesis and thecrimping device and additionally to reduce forces of disposing theendoprosthesis in a delivery device. Additionally, the lubricant mayreduce deployment force thereby increasing accuracy of endoprosthesisplacement within a patient. The lubricant may be introduced prior to,during, or after the crimping or loading process.

Various different manufacturing techniques are well known and may beused for fabrication of the endoprosthesis of the present invention. Forexample, and in a preferred embodiment, the endoprosthesis can be formedfrom a hollow tube of suitable material using a known technique, such asby laser cutting, EDM, milling, chemical etching, hydro-cutting, and thelike. The shaped structure can be mechanically blasted with a media andthen electropolished or otherwise finished to remove burrs and eliminatesharp edges and contaminates. An additional de-scaling process may beperformed before electropolishing, wherein the de-scaling processinvolves the use of an acid bath.

Alternatively, the endoprosthesis can be fabricated from a sheet ofsuitable material using a similar cutting, milling, or etchingtechnique, and then rolled or bent about a longitudinal axis into thedesired shape. If desired, the lateral edges of the structure can bejoined together, such as by welding or bonding, to form a closed tubularstructure, or the lateral edges can remain unattached to form a coiled,rolled sheet or open tubular structure.

Conversely, a suitable material of construction can be appliedselectively to a substrate to define the desired pattern of theendoprosthesis structure, and then the substrate can be removed. Othermethods of manufacture also can be used for the endoprosthesis of thepresent invention, such as by bending toroidal rings or elongate lengthsof wire into appropriately shaped members, such as that corresponding toeach annular ring, and then joining the appropriately shaped memberstogether at connection locations by a welding or bonding technique orthe like. If a shape memory material is used, such as nitinol, thefabricated structure can be heat treated on a mandrel or the like usingknown techniques to establish the desired endoprosthesis shape anddimensions at a predetermined temperature (e.g., when above austenitictransition temperature). In one embodiment, a tube having a first set ofdimensions can be fabricated to include endoprosthetic elements. Thiscan include obtaining a tube of a suitable material and forming theendoprosthetic elements. The tube can then be drawn down to a smallersize of an implantable endoprosthesis. Additional processing well knownin the art can then be used to condition the endoprosthesis for use.Thus, multiple implantable endoprostheses can be prepared from the tubehaving the first set of dimensions.

An additional step of passivation can be performed during themanufacturing stage of the endoprosthesis in order to form a homogeneousoxide layer for corrosion resistance. The passivation process may beperformed prior to installation of the markers in accordance with thepresent invention or it may be performed after installation ofradiopaque markers. Alternatively, multiple passivation processes may beperformed, once prior to insertion of the markers and again afterinsertion of the markers.

As originally cut and/or fabricated, the endoprosthesis can correspondto its delivery configuration or to a deployed configuration or aconfiguration therebetween. Preferably, however, the endoprosthesis canbe fabricated with a configuration at least slightly larger than thedelivery configuration as shown in the planar formats of FIGS. 1 and 6,for example. In this manner, the endoprosthesis can be crimped orotherwise compressed into its delivery configuration in a correspondingdelivery device.

In another preferred embodiment, the endoprosthesis can be originallyfabricated from a tube having a diameter corresponding to the deployedconfiguration. The endoprosthesis can be designed to match the targetvessel in which the endoprosthesis is to be deployed. As previouslynoted, the geometry of each component of the endoprosthesis orendoprosthetic element, such as the width, thickness, length and shapeof the strut elements, bar arms, connectors, multi-stage crest elements,crests, valleys, elbows, link arms, and the like can be preferablyselected to obtain predetermined expansion, flexibility, foreshortening,coverage scaffolding, and cross-sectional profile characteristics. Forexample, longer bar arms and/or connectors can promote greater radialexpansion or scaffolding coverage. The phase difference orcircumferential alignment between adjacent annular rings likewise can bealtered to control coverage and flexibility. Similarly, the number andplacement of connection locations and, if present, the connectors,between longitudinally-adjacent annular rings can be preferably selectedto obtain the desired flexibility of the endoprosthesis. The number ofmulti-stage crest elements in each annular ring also can be varied toachieve desired performance characteristics.

The present invention may be embodied in other specific forms withoutdeparting from its spirit or essential characteristics. The describedembodiments are to be considered in all respects only as illustrativeand not restrictive. The scope of the invention is, therefore, indicatedby the appended claims rather than by the foregoing description. Allchanges which come within the meaning and range of equivalency of theclaims are to be embraced within their scope.

What is claimed is:
 1. An endoprosthesis for delivery in a body lumen, the endoprosthesis comprising: at least one annular ring having a first annular longitudinal side, a second annular longitudinal side each defining opposite longitudinal ends of the at least one annular ring, and a longitudinal axis that extends between the first and second longitudinal sides, the at least one annular ring crimped into a delivery configuration and configured to be expanded into a deployed configuration to provide scaffolding support to a lumen, the at least one annular ring comprising: a plurality of circumferentially-adjacent bar arms comprising at least a first bar arm and a circumferentially-adjacent second bar arm, each of the first and second bar arms having a first end adjacent the first longitudinal side and a second end adjacent the second longitudinal side, the second ends being circumferentially offset from the first ends such that each bar arm is generally obliquely oriented relative to the longitudinal axis; and at least one multi-stage crest element connecting the first end of the first bar arm to the first end of the second bar arm, the at least one multi-stage crest element having a plurality of link arms connected to one another with a plurality of elbows, the plurality of link arms comprising a first link arm and a second link arm, each of the first and second link arms having a first end and a second end, the second ends being circumferentially offset from the first ends such that each link arm is generally obliquely oriented relative to the longitudinal axis, the plurality of elbows including a first transition elbow connecting the first end of the first link arm to the first end of the first bar arm and a second transition elbow connecting the first end of the second link arm to the first end of the second bar arm, wherein the first transition elbow, the first link arm and the first bar arm are completely disposed completely between and space completely from the first longitudinal side and the second longitudinal side of the at least one annular ring, and wherein the arrangement and configuration of the plurality of link arms, the plurality of elbows, and the first and second bar arms distributing strains experienced by the at least one annular ring during crimping and expansion to limit fatigue and damage from the strains.
 2. An endoprosthesis as in claim 1, wherein the strains experienced by the at least one annular ring during crimping and expansion include a combination of compressive strains and tensile strains.
 3. An endoprosthesis as in claim 2, wherein each elbow of the plurality of elbows experiences both a tensile strain and a compressive strain when the at least one annular ring is in the delivery configuration and in the deployed configuration.
 4. An endoprosthesis as in claim 1, wherein the plurality of elbows comprise at least three elbows and each of the at least three elbows comprise: a strain region that experiences a tensile strain when the at least one annular ring is in the delivery configuration and a compressive strain when the at least one annular ring is in the deployed configuration; and a strain region that experiences a compressive strain when the at least one annular ring is in the delivery configuration and a tensile strain when the at least one annular ring is in the deployed configuration.
 5. An endoprosthesis as in claim 1, wherein the plurality of elbows comprise at least three elbows and each of the at least three elbows comprise: a strain region that experiences a tensile strain when the at least one annular ring is in the delivery configuration and when the at least one annular ring is in the deployed configuration; and a strain region that experiences a compressive strain when the at least one annular ring is in the delivery configuration and when the at least one annular ring is in the deployed configuration.
 6. An endoprosthesis as in claim 1, wherein the plurality of elbows of the at least one multi-stage crest element comprises five elbows connecting four link arms together end to end.
 7. An endoprosthesis as in claim 1, wherein the plurality of elbows comprises at least three elbows, wherein the distances between the at least three elbows change as the at least one annular ring expands from the delivery configuration to the deployed configuration.
 8. An endoprosthesis as in claim 1, wherein each of the plurality of link arms is generally obliquely oriented relative to the longitudinal axis of the at least one annular ring when the at least one annular ring is in the delivery configuration.
 9. An endoprosthesis as in claim 1, wherein each of the plurality of bar arms is oriented generally perpendicular to the longitudinal axis of the at least one annular ring when the at least one annular ring is in the deployed configuration.
 10. An endoprosthesis as in claim 1, wherein the first end of each bar arm of the plurality of bar arms is connected to a multi-stage crest element that opens in a first direction and the second end of each bar arm of the plurality of bar arms is connected to a multi-stage crest element that opens in a second direction.
 11. An endoprosthesis for delivery in a body lumen, the endoprosthesis comprising: at least one annular ring having a first annular longitudinal side, a second annular longitudinal side each defining opposite longitudinal ends of the at least one annular ring, and a longitudinal axis that extends between the first and second longitudinal sides, the at least one annular ring crimped into a delivery configuration and configured to be expanded into a deployed configuration to provide scaffolding support to a lumen, the at least one annular ring comprising: a plurality of circumferentially-adjacent bar arms including a first bar arm and a second bar arm, each bar arm of the plurality of bar arms having a first end and a second end; and at least one multi-stage crest element connecting the first end of the first bar arm to the first end of the second, circumferentially-adjacent bar arm, the at least one multi-stage crest element having a plurality of link arms connected to one another with a plurality of elbows, link arms from the plurality of link arms and elbows from the plurality of elbows being connected to one another to define an opening through the at least one multi-stage crest element, wherein the plurality of elbows include a first transition elbow linking the first end of the first bar with the at least one multi-stage crest element and a second transition elbow linking the first end of the second bar arm with the at least one multi-stage crest element, the first transition elbow and the second transition elbow being disposed completely between and spaced completely from both longitudinal sides of the at least one annular ring, the arrangement and configuration of the plurality of link arms and the plurality of elbows distributing strains experienced by the at least one annular ring during crimping and expansion.
 12. An endoprosthesis as in claim 11, wherein the link arms that cooperate to define the opening through the at least one multi-stage crest element are arranged relative to one another so that the opening through the at least one multi-stage crest element is generally diamond shaped.
 13. An endoprosthesis as in claim 12, wherein the opening in the at least one multi-stage crest element longitudinally lengthens and vertically shortens when the at least one annular ring is crimped into the delivery configuration.
 14. An endoprosthesis as in claim 11, wherein the opening in the at least one multi-stage crest element longitudinally shortens and vertically lengthens when the at least one annular ring is expanded into the deployed configuration.
 15. An endoprosthesis as in claim 11, wherein the at least one annular ring comprises a plurality of longitudinally spaced apart annular rings, each annular ring of the plurality of annular rings being connected to at least one other annular ring with at least one connector.
 16. An endoprosthesis as in claim 15, wherein the at least one connector is connected to a multi-stage crest element of a first annular ring and a multi-stage crest element of a second annular ring.
 17. An endoprosthesis as in claim 11, wherein each of the plurality of bar arms is oriented obliquely to a longitudinal axis of the at least one annular ring when the at least one annular ring is in the delivery configuration.
 18. An endoprosthesis for delivery in a body lumen, the endoprosthesis comprising: a plurality of longitudinally spaced apart annular rings crimped into a delivery configuration and configured to be expanded into a deployed configuration to provide scaffolding support to a lumen, each of the plurality of longitudinally spaced apart annular rings having a first longitudinal side defining a first longitudinal end and a second longitudinal side defining a second longitudinal end, each annular ring comprising: a plurality of circumferentially-adjacent bar arms, each bar arm of the plurality of bar arms having a first end and a second end; a first plurality of multi-stage crest elements extending along the first longitudinal side and connecting the first ends of circumferentially-adjacent bar arms to one another, each multi-stage crest element of the first plurality comprising a plurality of link arms and a plurality of elbows arranged in a substantially similar configuration as the other multi-stage crest elements of the first plurality, wherein first transition elbows included in the plurality of elbows link the first plurality of multi-stage crest elements to the first ends of the bar arms and link the first plurality of multi-stage crest elements with another elbow of the plurality of elbows of the first plurality of multi-stage crest elements forming a portion of a periphery of the first longitudinal end; and a second plurality of multi-stage crest elements extending along the second longitudinal side and connecting the second ends of circumferentially-adjacent bar arms to one another, each multi-stage crest element of the second plurality comprising a plurality of link arms and a plurality of elbows arranged in a substantially similar configuration as the other multi-stage crest elements of the second plurality, the second plurality of multi-stage crest elements being a substantially mirror image of the first plurality of multi-stage crest elements to facilitate substantially uniform crimping and expansion of each annular ring of the plurality of annular rings, wherein second transition elbows included in the plurality of elbows link the second plurality of multi-stage crest elements to the second ends of the bar arms and link the second plurality of multi-stage crest elements with another elbow of the plurality of elbows of the second plurality of multi-stage crest elements forming a portion of a periphery of the second longitudinal end; and a plurality of connectors connecting each annular ring to at least one other annular ring.
 19. An endoprosthesis as in claim 18, wherein link arms from each plurality of link arms and elbows from each plurality of elbows are connected to one another to define a generally diamond shaped opening through each multi-stage crest element.
 20. An endoprosthesis as in claim 18, wherein the first plurality of multi-state crest elements and the second plurality of multi-state crest elements are circumferentially offset from one another to facilitate the substantially uniform crimping and expansion of each annular ring. 